Management of penetrating wounds of the neck

Abstract

Management policies for penetrating wounds of the neck vary from mandatory surgical exploration to selective surgical exploration following extensive or minimal imaging investigation. In order to review the treatment protocol at Sheba Medical Center, Tel Hashomer, Israel, we retrospectively studied 21 patients who were treated between the years 1984 and 1989. Thirteen had gunshot injuries and eight had stab wounds. Eight patients had undergone immediate exploration of the neck. Four patients had died, but all of these latter patients had evidence for significant bleeding that could have been detected within a short time of admission. On the basis of our findings and previous studies, we conclude that: presenting features of neck injuries should be differentiated into two basic categories: immediately life-threatening and not immediately life-threatening. Immediately life-threatening features include overt massive bleeding, expanding hematoma, non-expanding hematoma in the presence of hemodynamic instability, hemomediastinum, hemothorax, and hypovolemic shock. In all of these cases, immediate surgical exploration is mandatory. Non-life-threatening features include any signs of vascular complication in a hemodynamically stable patient, signs of upper aerodigestive tract lesions (when initial treatment has already relieved respiratory distress) and peripheral neurological deficits. These patients should undergo thorough imaging investigations on the basis of which the need for and the nature of possible surgical intervention can be determined.

Penetrating Neck Injury: A Case Report and Review of Management

“…Zone 3 contains the internal and external carotid arteries, jugular vein, lateral pharynx, and cranial nerves VII, IX, X, XI, and XII [2].…”

“…Penetrating neck injuries represent approximately 5-10 % of all trauma cases that present to the emergency department and result in significant mortality [1,2]. Management requires a logical approach with swift assessment of the adequacy of airway and circulation and of the possible presence of any skeletal or neurological damage prior to operative intervention.…”

Penetrationsverletzungen des Halses, Verletzungsmuster und diagnostischer Algorithmus

“…cherne Skelett eine vollständige klinische Untersuchung erschwert und eine erweiterte radiologische oder endoskopische Diagnostik wichtige Aufschlüsse über das Verletzungsausmaû geben sollte [6,9,12]. cherne Skelett eine vollständige klinische Untersuchung erschwert und eine erweiterte radiologische oder endoskopische Diagnostik wichtige Aufschlüsse über das Verletzungsausmaû geben sollte [6,9,12].…”

Pf�hlungsverletzung des Halses

“…Das Vorliegen eines Intimadefekts im Bereich der Halsgefäße wird durch die klinische Untersuchung allerdings nicht erfasst [12]. Diese müssen zwar initial nicht chirurgisch versorgt werden,können aber zu einer Dissektion oder Thrombose des Gefäßes führen und dann zu einer Revision zwingen.…”

“…Unabhängig von Lage und Ausmaß der Perforationsverletzung sollte eine antibiotische Therapie [12] und eine Tetanusprophylaxe erfolgen [2,15]. …”