An audit of surgical neck explorations for penetrating neck injuries in northwestern Nigeria: Experience from a teaching hospital

Abstract

Background: Penetrating neck injury is a major trauma mechanism present in about 5%–10% of trauma patients with an estimated mortality of 3%–10%. The management of these injuries is dependent on the anatomical level of injury. Objectives: The objective of the study was to document the clinical and operative findings as well as the treatment outcome among our patients who underwent neck exploration for penetrating neck injuries. Materials and Methods: A retrospective review of patients who had neck exploration for penetrating neck injury between January 2012 and December 2018 was done. Results: Thirty-five patients all of whom had surgical neck exploration were included. The age ranged from 15 to 62 years with a male: female of 7.8:1. The mean age was 30.7 years with standard deviation of ± 12.5 years and the peak age of occurrence of 20–29 years. The mechanism of injury was commonly arrow injury in 9 (25.7%) and suicidal cutthroat in 7 (20%) patients. Thirty-two (91.4%) patients presented with stable vital signs. Zone II neck injuries were most prevalent, seen in 23 (65.7%) patients. Laryngeal injury in 7 (20%) and soft-tissue injury in 7 (20%) of the patients were the most common intraoperative findings. The complication rate of 17.1% with a mortality rate of 2.9% was recorded. There was a statistically significant association between the presence of vascular injury and the development of complications after exploration (Chi-square = 5.666, P = 0.017). It was also a significant positive predictor of complication following neck exploration (odds ratio = 0.017, P = 0.048). Conclusion: Male young adults were most involved, commonly from arrow and stab injuries. Although laryngeal and soft-tissue injuries were predominant, vascular injuries were most associated with postoperative complications.

‘No zone’ approach in the management of penetrating neck injuries – an Australian Tertiary Trauma Centre experience

“…This may be due to relatively lower rates of assault, compared to other countries commonly examining PNIs, such as the USA and South Africa; less firearm‐related violence in Australia; and possibly higher rates of hospitalization for other traumas, such as falls, motor vehicle accidents and sporting incidents. The patient population was predominantly male (82.8%) with a median age of 35, which aligns with data from around the world including the UK, 15,16 Africa, 17–19 Asia 8 and the USA 6,20 . However contrary to US studies where up to 40% of PNI's are due to gunshot wounds, only 8 patients (3.9%) were firearm‐related in our series, which is more in keeping with UK 16 and South African 18 data, likely owing to national laws around firearm possession and use.…”

“…6,16 Our average LOS (6.4 days) fell within ranges reported in the literature, with median LOS described between 3 and 7 days. 8,19,21 One Nigerian study did report a mean LOS of 16.5 days, 17 which is considerably higher than other quoted figures. This could relate to differences in injury severity (as this cohort only included patients who had neck explorations), discharge protocols or resource availability.…”

“…Of these, 204 patients were included in the analysis. Thirty-four were excluded due to lack of documentation (10), posterior neck injuries (17), facial/mandibular injuries (2), blunt neck injuries (2), and death on arrival (3). Fortyone (20.0%) injuries occurred in Zone 1, 146 (71.6%) in Zone 2, and 17 (8.3%) in Zone 3.…”