Bullet wounds of the trachea

Abstract

During the past 10 years, 18 patients with gunshot wounds of the trachea, 13 of the cervical and five of the intrathoracic trachea, were admitted to Grady Memorial Hospital. There were 16 male and two female subjects with ages ranging from 15 to 60 years. In addition to the tracheal injuries, four patients had injuries to major vessels and six patients had esophageal injury, four of the cervical and two of the intrathoracic esophagus. Three patients with esophageal injury had tracheoesophageal fistula. The diagnosis of tracheal injury was suspected because of the site of the wound and the clinical manifestations; hemoptysis, air escaping from the cutaneous wound, subcutaneous emphysema, and so on. This was confirmed by tracheoscopy in nine patients, by exploratory operation in eight patients, and when the bullet was expectorated in one patient. The treatment of the tracheal injury was dependent upon the magnitude of the tracheal wound and the presence of injury to adjacent organs. Seven patients underwent primary repair of the tracheal wound, two had primary repair with reinforcement of the suture line with tissue flap, three had repair of the tracheal wound and tracheostomy, one underwent construction of a tracheocutaneous stoma, two had temporary orotracheal intubation for 24 to 48 hours, and three patients were observed. Seventeen patients recovered from the injuries and one patient, with extensive tracheal and esophageal injury and extensive mediastinal infection, died of respiratory insufficiency. This study suggests that the management of bullet wounds of the trachea should be individualized according to the magnitude of the wound and the presence of other organ injury. Primary repair without concomitant tracheostomy can be accomplished with gratifying results in the majority of civilian victims.