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Complications of cervical injury repairs

Complications of cervical injury repairs
Complication Source Management Tips
Postoperative bleed Arterial repair Reoperation:
  • Early – Open repair
  • Late – Consider endovascular approach
Postoperative cervical bleed in an extubated patient may develop into a threatened airway
Arterial thrombosis

Carotid

  • Common – Concern is CVA
  • External – Not clinically significant
  • Internal – Concern is CVA

Consider reoperation for common carotid. For internal carotid, treatment is based on timing and risk of CVA. For thrombolysis, endovascular approach is best.

 Need to confirm no neurologic changes or a CT scan to rule out hemorrhagic CVA prior to systemic anticoagulation
Venous thrombosis Internal jugular Not clinically significant unless it is infected. Anticoagulation required in the setting of infection or inflammation.

PE is uncommon

Infected thrombosis more common
Tracheal leak Anastomotic leak Consider stent placement versus reoperation with muscle flap. High risk of stent migration
Esophageal leak Anastomotic leak Consider stent placement versus reoperation with muscle flap. High risk of stent migration
Mediastinal infection Tracheal or esophageal anastomotic leak Requires adequate drainage either cervical or thoracoscopic drainage in addition to broad-spectrum antibiotics. Must be diagnosed early as it carries a high risk of death
Thoracic duct injury Injury to the thoracic duct at the base of the L neck

Initial management is dietary restriction (low-fat diet), or TPN +/– octreotide.

If not resolved in 2 to 4 weeks may require thorascopic ligation to thoracic duct in the chest.		 Patience will be necessary
CVA: cerebrovascular accident; CT: computed tomography; PE: pulmonary embolism; TPN: total parenteral nutrition.
Graphic 121262 Version 1.0

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