Each preceding chapter has figures, tables, and drawings that aid the author and the editors in imparting and clarifying the messages of the chapter. In this edition of TRAUMA, the editors have devoted a special section to an atlas. It is not intended to include an exhaustive artistic rendering of every operation, but, rather, to focus on procedures that are commonly used in major trauma operations, along with related anatomical drawings. Some procedures that may have been commonly practiced in the past but are rarely currently done are not included. However, a few relatively infrequently used concepts and procedures have been included in this section because of sufficient need to clarify the opinions of the editors. The art has been kept in as simple a form as possible, so it is expeditiously available when needed for a quick refresher in anatomy, anatomical relationships, and/or surgical approach in the “heat of battle.”
Figure 1 Nasal Packing for Hemorrhage Control
A. Under general or topical anesthesia, gauze impregnated with Vaseline to facilitate insertion is layered into a bleeding nasal passage to achieve hemostasis
B. Balloon devices are commercially available to provide posterior and anterior nasal packing
Figure 2 Steps in Performing a Lateral Parietal Craniectomy
A. The exact location and size of the skin flap vary, depending on extent of the wound but must not extend to the midline at the top of the skull
B. Skin clips are placed for hemostasis, and burr holes elevate the skull bone flap
C–D. The bone flap is removed, the dura mater is opened to expose and release an epidural hematoma, and bleeding vessels are ligated. In the absence of significant brain swelling, the skull plate is reattached once hemorrhage is controlled and other necessary procedures have been accomplished. With significant brain swelling, the dura is closed, sometime using dural substitutes, and the bone flap is not replaced at initial operation (decompressive craniotomy)
Figure 3 Anatomy of the Neck
A. Anterior Perspective—Although usually approached from incisions just anterior to the sternocleidomastoid muscle, the surgeon must always review the cervical anatomy and its structural relationships prior to incision. The external jugular vein is a subcutaneous structure, and the internal jugular vein and carotid arteries are deep and medial in the neck
B. Lateral Perspective—The proximal ...
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