RESULTS OF MANDATORY EXPLORATION FOR PENETRATING NECK TRAUMA

Management of penetrating wounds to the neck remains controversial des pite decades of discussion in the literature. We assessed 393 consecut ive stab wounds penetrating the platysma operated at our trauma servic e between January 14, 1991 and September 30, 1992 to evaluate our poli cy of mandatory neck exploration (NE). Injury to the common (n = 19 ca ses), external (n = 7), internal carotid (n = 5), innominate (n = 2), subclavian (n = 20), vertebral (n = 12), facial (n = 2), and intercost al (n = 2) arteries; the external (n = 36), internal (n = 65), subclav ian (n = 20), and innominate (n = 4) veins; the pharynx/esophagus (n = 21); and the trachea (n = 28) was considered a positive NE (n = 167). 226 NEs were negative. Except for hemiparesis and bruit, the presence of clinical signs (shock, active hemorrhage, hematoma, surgical emphy sema, dysphagia, blowing wound) did not predict a positive NE, Clinica l signs were absent in 30% of positive NEs and in 58% of negative NEs. Complications of positive NE included wound infection (n = 7 cases), chyle drainage (n = 6), cerebellar stroke (n = 1), pneumonitis (n = 8) , reoperation for recurrent hemorrhage (n = 1), subclavian artery graf t occlusion (n = 1), bronchopleural fistula (n = 1), and cerebrospinal fluid leak (n = 1). Negative NEs were complicated by a mound infectio n in four cases and pneumonitis in one case. The mean hospital stay wa s 4.3 days for those with a positive NE and 1.5 days for those with a negative NE. Clinical signs are of no help in determining whether a st ab wound to the neck has led to potentially life threatening injury. M andatory NE saves unnecessary invasive diagnostic studies, is associat ed with negligible morbidity, and incurs only a short hospital stay.