PENETRATING INJURIES OF THE NECK - SELECTIVE MANAGEMENT EVOLVING

Since 1990, a selective management algorithm has been used in our Trau ma Center to treat 91 patients with penetrating neck injuries. Group A (n = 37) sustained zone I,zone III, or multiple-zone injuries; Group B (n = 54) sustained zone II injuries [most (55, 66.4%) from gunshot o r shotgun wounds]. Nineteen Group A and 21 Group B patients required m andatory neck exploration. Vascular or aerodigestive tract injuries we re found and adequately repaired in 15 Group A and 11 Group B patients . The superficial wounds of three Group A and seven Group B patients w ere closed, and the patients were observed for 24 hours. The remaining 15 Group A and 24 Group B patients underwent routine angiogram, arbit rary barium swallow, and, if necessary, esophagoscopy. Two of these Gr oup B patients required surgery for common carotid artery injuries. On e patient died 4 months later because of missed vertebral artery pseud oaneurysm. Overall mortality and complication rates were 6 and 1 per c ent. Unnecessary exploration was avoided in 52 per cent of cases regar dless of the location of the wound. Mortality and morbidity rates were acceptable. Patients with penetrating neck injuries could be safely m anaged selectively regardless of the injury zone.