• vascular injury
• internal carotid artery
• penetrating trauma
• operative trauma

A 27-year-old male patient presented to the Trauma Center with multiple gunshot wounds, including a wound to right zone II of the neck, three wounds to the posterior neck and intraoral wounds to the left soft palate. There was an associated expanding hematoma with pulsatile bleeding of the zone II neck wound and the patient was demonstrating lateralizing signs. Pressure was held to control bleeding and after completion of primary and secondary surveys the patient was transported to the operating room for exploration.

On induction of general anesthesia, an incision was made along the anterior border of the sternocleidomastoid muscle and carried down to the common carotid artery, and the vessel loop was encircled around it. There was active arterial and venous bleeding distally so the incision was extended and dissection was carried down to the internal jugular vein, which had an approximately 1 cm, near-circumferential defect in it and was ligated.

The internal carotid artery (ICA) was then further dissected up to the level of the injury, which was approximately 1.5 cm distal to the carotid bifurcation. Arterial bleeding from the ICA was temporarily controlled by digital pressure while distal control was obtained of the ICA and external carotid …