TRANSCERVICAL GUNSHOT INJURIES - MANDATORY OPERATION IS NOT NECESSARY

Background: It has been suggested that all transcervical gunshot wound s should be explored surgically because of the high incidence of injur ies to vital structures, The present prospective study investigated th e clinical presentation, the role of various diagnostic investigations , and the need for surgery in patients with transcervical gunshot inju ries, Methods: Ninety-seven patients sustained gunshot injuries to the neck and 33 of them (34%) were transcervical, All victims were assess ed clinically according to a written protocol and subsequently were ev aluated angiographically, and, in the appropriate case, by means of en doscopy and esophagography. Results: Overall, 24 (73%) of the 33 patie nts with transcervical gunshot wounds had injuries to cervical structu res, Vascular injuries were found in 48%, spinal cord injuries in 24%, and aerodigestive tract injuries in 6% of patients with transcervical injuries, In the 64 patients without midline crossing, the incidence of cervical structure injuries was 31%, Despite the high incidence of injuries to cervical structures in transcervical wounds, only 21% of t he patients had a therapeutic operation, The overall mortality was 3%, There were no in-hospital deaths or local complications in the nonope ratively managed group, Conclusions: The results of the present study do not support the current recommendations of mandatory operation for all transcervical gunshot wounds. A careful clinical examination combi ned with the appropriate diagnostic investigations should determine th e treatment modality. About 80% of these patients can safely be manage d nonoperatively.