Research Article| Volume 110, ISSUE 4, P649-655, October 1965

Spontaneous carotid artery hemorrhage after head and neck surgery

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      Through a planned program of anticipation and repeated orientation of all surgical personnel to the problems and procedures to be followed, seventeen of nineteen instances of massive spontaneous hemorrhage of the carotid artery have been successfully controlled. The restoration and stabilization of the patient's vital signs by point-pressure control of bleeding, maintenance of adequate ventilation, and rapid blood volume restoration, together with the emergency mobilization of hospital facilities, have allowed all but three of these patients to undergo successful ligation. No neurologic defects have resulted, and all have been restored to their prior “blowout” ambulatory status. Removal of a portion of the medial clavicle often facilitated ligation and wound closure.
      The common etiologic factor in this series of spontaneous hemorrhage of the carotid artery has been the combination of surgery for postirradiation recurrent cancer which was subsequently followed by wound breakdown secondary to tissue necrosis or fistula formation. In addition, tumor either grossly or microscopically has been present in at least seven instances. Three carotid artery hemorrhages in two patients occurred from infection alone after radical surgery.
      The incidence of spontaneous hemorrhage of the carotid artery has significantly decreased since, at the time of surgery, skin incisions overlying the carotid are avoided, all carotids are routinely covered with muscle flaps, and antibiotic prophylaxis is employed.
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