Validity of no-zone approach for management of isolated penetrating neck injuries in hemodynamically stable patients

Abstract

Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of unnecessary interventions and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography (CTA) to guide treatment. The aim was to assess the validity of the no-zone approach in the management of isolated PNIs in hemodynamically stable patients.Methods: This retrospective study included patients with isolated PNIs with soft signs who were hemodynamically stable. They were classified into patients with negative CTA findings and were managed conservatively and patients with positive CTA findings suspecting aerodigestive tract injuries (ADTIs) who were submitted to further selective investigations to confirm or rule out these injuries. Detected injuries were managed accordingly.Results: This study included 106 PNIs patients who had soft signs and were hemodynamic stable. 37 cases (34.9%) had negative CTA findings and were managed conservatively. Sixty nine patients (65.1%) had positive CTA findings and were subjected to subsequent selective investigations and revealed 3 patients with negative endoscopic findings who passed without need for any surgical intervention. Therefore, 40 (37.7%) patients were saved from surgery with no missed injuries. Patients with definitive injuries (66 patients) underwent neck exploration and managed accordingly. No missed injuries were recorded in this study. Complications were detected in 6 cases (5.7%) while death was recorded in 2 cases (1.9%).Conclusions: No-zone approach offers a safe management protocol for isolated PNIs in hemodynamically stable patients. It provides no missed injuries, negligible rates of negative exploration and minimal complications and mortality.