Neck wounds in modern armed conflicts: a review of diagnostic and treatment tactics

   This article addresses the complex challenge of managing penetrating neck injuries, a problem of heightened relevance in modern armed conflicts. The high density of vital structures in this area results in significant mortality, which is directly dependent on the speed of diagnosis and choice of surgical strategy.

   Injuries to major veins pose a particular danger, as they can manifest clinically after a delay, creating a "lucid interval" or period of false stability.

   The core of the work is a clinical case of a 27-year-old serviceman with a stab wound to zone I of the neck.

   Following initial wound management and seven days of stable condition, the patient experienced bleeding triggered by coughing. Emergency duplex ultrasound scanning revealed a defect in the wall of the brachiocephalic vein, a paravascular hematoma, and a floating thrombus, necessitating urgent surgical intervention. An open surgical procedure was performed: the injured vein and its tributaries were isolated, the hematoma was evacuated, the floating thrombus was removed, and the venous wall defect was repaired with a primary suture. Postoperative management included antibiotic therapy and anticoagulants. The patient was discharged fit for duty on day 30. The discussion emphasizes that this case illustrates key aspects of contemporary combat surgery: 1. Diagnosis: a high index of suspicion is essential, as stable hemodynamics do not rule out severe underlying injury. Duplex ultrasound is a critically important screening tool in field conditions. 2. Tactics: for a
confirmed major venous injury with a floating thrombus, open surgery with thrombectomy remains the treatment of choice, ensuring a definitive and radical solution. 3. Organization: success was driven by a multidisciplinary team-based decision-making approach and an effective two-stage evacuation system adhering to "damage control" principles. 4. Management: comprehensive postoperative therapy, including anticoagulation, is mandatory for preventing thromboembolic complications.

   The article's conclusions affirm the efficacy of current protocols, which are founded on early instrumental diagnostics, timely specialized surgery, and interdisciplinary collaboration across all stages of medical evacuation.

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