Penetrating Neck Trauma: a Review (original) (raw)

Evaluation of Penetrating Injuries of the Neck: Prospective Study of 223 Patients

World Journal of Surgery, 1997

The objective of this study was to assess the role of clinical examination, angiography, color flow Doppler imaging, and other diagnostic tests in identifying injuries to the vascular or aerodigestive structures in patients with penetrating injuries to the neck. A prospective study was made of patients with penetrating neck injuries. All patients had a careful physical examination according to a written protocol. Stable patients underwent routine four-vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proximity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigestive tract structures in the neck. Altogether 223 patients were entered in the study. After physical examination 176 patients underwent angiography and 99 of them underwent color flow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color flow Doppler imaging was performed on 99 patients with a sensitivity of 91.7%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99%. These values were all 100% when only injuries requiring treatment were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 100%), although angiography in 127 showed 11 vascular lesions not requiring treatment. "Hard" signs on clinical examination (large expanding hematomas, severe active bleeding, shock not responding to fluids, diminished radial pulse, bruit) reliably predicted major vascular trauma requiring treatment. Among 34 of the 223 total patients (15.2%) admitted with "soft" signs, 8 had angiographically detected injuries, but only one required treatment. An esophagogram was performed on 98 patients because of proximity injuries (49 patients) or suspicious clinical signs (49 patients), and two of them showed esophageal perforations. None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that physical examination is reliable for identifying those patients with penetrating injuries of the neck who require vascular or esophageal diagnostic studies. Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injuries is suggested.

Management Of Penetrating Neck Injuries: Zone II

Journal of Surgical Education, 2007

Purpose: To examine the results of physical examination alone in the evaluation of penetrating zone II neck injuries for vascular trauma. Design: Retrospective chart review. Setting: University-based level 1 trauma center. Methods: Retrospective review of all patients admitted to a level 1 trauma center between December 1991 and April 1999 with penetrating zone II neck injuries. Participants: A total of 145 patients presenting with penetrating neck injuries to a level 1 trauma center between December 1991 and April 1999. Results: A total of 145 patients were included; 30 of these patients had penetrating wounds traversing multiple zones.

Management of penetrating neck injury in the emergency department: a structured literature review

Emergency Medicine Journal, 2008

The management of patients with penetrating neck injuries in the prehospital setting and in the emergency department has evolved with regard to the necessity for spinal immobilisation and the use of multidetector computed tomographic (MDCT) imaging. Questions also arise as to choices of securing a threatened or compromised airway. A structured review of the medical literature was conducted to provide current recommendations for the management of patients with penetrating neck injury. Methods: Databases for PubMed, MEDLINE, CINAHL and Cochrane EBM Reviews were electronically searched using the subject headings ''penetrating neck injury'', ''penetrating neck trauma'', ''cervical immobilization'', ''multi-detector CTA'' and ''airway management''. The results generated by the search were limited to English language articles and reviewed for relevance to the topic. Results: 122 citations were identified that met the criteria for emphasis on emergency department care, cervical spine immobilisation, use of multidetector CT angiography or airway management. After excluding case series, non-peer reviewed articles and editorials, 20 articles were identified and reviewed. Conclusions: The current literature suggests that prehospital cervical immobilisation may not be necessary unless the patient has focal neurological deficits. Studies show that patients with penetrating neck trauma who are haemodynamically stable and exhibit no ''hard signs'' of vascular injury may be evaluated initially by MDCT imaging even when platysma violation is present. Airway management is evolving, but traditional laryngoscopy continues to be the mainstay of airway stabilisation.

Penetrating neck injury: a case report and review of management

The Indian journal of surgery, 2013

Penetrating neck injury constitutes 5-10 % of all cases seen in the emergency room. As surgeons we must be prepared to manage these cases. After stabilizing the general condition of the patient the neck injuries are assessed. Management has changed from routine exploration to selective exploration. Injury to aerodigestive tract and vessels are commonly seen.

A tailored protocol in management of penetrating neck injuries: experience at a level 1 trauma centre

International Surgery Journal

Background: The management of penetrating neck injuries (PNIs) evolved markedly over last year’s towards more conservative approaches. Recent improvements in imaging modalities as multi-detector CT-angiography (MDCT-A) produced a paradigmatic shift towards 'no-zone' approach. In this study, we adopted a tailored protocol to deal with such injuries with less dependency on zone classification.Methods: This prospective study included patients with PNIs from February 2012 to January 2014. Unstable patients and patients with hard signs in zone-II were managed by immediate exploration. Patients with hard signs in zones-I and III had MDCT-A to check feasibility of endovascular intervention. However, all patients with soft signs and asymptomatic patients underwent MDCT-A regardless the zone affected to determine the need for therapeutic intervention. Complementary investigations were added in some cases with equivocal MDCT-A results.Results: Our study included 85 patients. Majority ...

Evaluation and management of neck trauma

Emergency medicine clinics of North America, 2007

Blunt and penetrating trauma to the neck can result in life-threatening injuries that demand immediate attention and intervention on the part of the emergency physician and trauma surgeon. This article provides a literature-based update of the evaluation and management of injuries to aerodigestive and vascular organs of the neck. A brief review of cervical spine injuries related to penetrating neck trauma is also included. Airway injuries challenge even the most skilled practitioners; familiarity with multiple approaches to securing a definitive airway is required because success is not guaranteed with any single technique.

Penetrating injuries of the neck: Criteria for exploration

Annals of Emergency Medicine, 1983

TABLE I Criteria A review of 271 patients with penetrating wounds of the neck is presented. A policy of selective conservative management appears 1. Scvere bleedi totally justified in view of the low mortality and morbidity in this (a) rapid ble series. Particular attention has been paid to the presentation and (b) shock wit surgical approach to the injured vertebral artery.

CT Angiography in Penetrating Neck Trauma Reduces the Need for Operative Neck Exploration

The American Surgeon, 2005

The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA ( P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA ( P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast e...

Penetrating Neck Injuries: from ER to OR

Indian Journal of Otolaryngology and Head & Neck Surgery, 2018

Neck contains several vital structures, in a small close space, in complex relationship to each other, and unprotected by any bony framework. Any injury to this crucial region, hence mostly becomes an acute emergency. Appropriately managing the same has always been a point of constant discussion amongst head and neck surgeons. The basic aim of the study was to discuss the management, comorbidities, prognosis and associated complications encountered in a series of patients with penetrating neck trauma (piercing platysma), presenting to the emergency over a period of 1 year. Combat injuries and patients declared as brought dead at the time of first examination were excluded. This was a retrospective study of patients with cut throat injury, managed at a tertiary center of northern India from June 2014 to September 2015. Following management in the ER as per ATLS guidelines, all patients were then operated for specific injuries. Graph pad software was used for statistical analysis. Of the 15 patients studied in total, 11 (73.3%) were males. The mean patient age was 33.67 years. Mean duration of presentation was 20.85 h. 60% patients had homicidal injuries. Tracheostomy and Ryle's tube insertion was done in 8 (53.3%) patients. Exploration and surgical repair was done in all patients without any mortality. 4 patients developed postoperative complications. Mean duration of hospital stay was 9.2 days. Immediate resuscitation followed by exploration and primary repair is a must in all patients of penetrating neck injury.

Continued experience with physical examination alone for evaluation and management of penetrating zone 2 neck injuries: Results of 145 cases

Journal of Vascular Surgery, 2000

The management of penetrating zone 2 neck injuries without hard signs of vascular injury has been controversial for more than half a century. The arguments have changed over the years, but there is no uniformly accepted management plan despite hundreds of articles on the subject. Although it is a reasonable option in military situations, 1-3 few people still advocate mandatory cervical exploration in asymptomatic patients. The routine use of arteriography (AG), which has been termed "selective management," is currently the most common practice in most trauma centers. Others advocate the use of duplex ultrasound scanning (US) to selectively manage patients. 8 One of the first prospective studies to evaluate the use of physical examination (PX) alone for confirming or excluding vascular injury in this setting was reported from our institution. 9 This approach was found to be safe and reliable in deter-