Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach

Abstract

Background: Many current protocols for managing penetrating neck injuries (PNIs) still suggest zonal approaches. This study was undertaken to determine the correlation between the zone of the external wound and the level of the internal injury, and to verify whether a 'no-zone' approach to PNI is valid. Methods: Patients admitted with a PNI to a tertiary trauma care centre between January 2011 and May 2018 were identified from a trauma database. Those with confirmed injury to the vascular system or an aerodigestive tract injury (ADTI) were included in the study. The medical records of each patient were reviewed with regard to the zone of the external wound and the level of internal injury, and the findings were compared. Results: In the period under review, 1075 patients were treated for a PNI. Of these, 298 (27⋅7 per cent) had a confirmed vascular injury or ADTI and were included in the cohort. In 176 patients (59⋅1 per cent) the site of the internal injury was in the same zone as the external wound. In a further 70 patients (23⋅5 per cent) there was no correlation between the site of the internal injury and the external wound, and in the remaining 52 patients (17⋅4 per cent) the correlation could not be determined. In this cohort, all clinically assessable patients with significant injuries had either physical signs suggestive of injury or deep surgical emphysema on radiological examination. Conclusion: An approach to PNI based on zones is questionable, and this study supports a no-zone approach based on imaging guided by clinical examination.

Penetrating neck trauma with laryngeal exposure: A case report

“…The increased evidence suggest that no-zone approach can adequately identify aerodigestive and vascular injuries in penetrating neck wounds, while avoiding invasive diagnostic procedures used in the zone-based approach [4]. Besides, some literature also demonstrated poor correlation between the location of the external injury and damaged internal structures [12,13]. In our case, neck exploration was performed immediately because of the presented hard signs as airway compromise and active bleeding.…”

Thoracic esophageal injury due to a neck stab wound: a case report

“…In this case, there was an esophageal injury caudal to the neck wound. Some studies argue against using the zone classification approach, stating that there is no correlation between the height of the trauma site and the internal injury site [ 17 ].…”

The Role of CT Scan in the Work-Up and Management of Blunt and Penetrating Trauma and Acute Surgical Emergencies - A Focused Literature Review

“…[19] Diagnostic evaluation of injuries has evolved over the past few decades from an operative versus non-operative approach, as defined by the neck zones involved, to more selective management based on the combination of the mechanism of injury, signs and symptoms, anatomic location of the wound, and increased use of computed tomography (CT). [20,21] Currently, the no zone approach is used in penetrating cervical trauma, where all the stable patients with an injury that breaches the platysma are investigated with the CT neck which includes the angiogram phase. CT imaging enables visualization of multiple structures across all three zones of the neck [20,21].…”

“…[20,21] Currently, the no zone approach is used in penetrating cervical trauma, where all the stable patients with an injury that breaches the platysma are investigated with the CT neck which includes the angiogram phase. CT imaging enables visualization of multiple structures across all three zones of the neck [20,21].…”