MANAGEMENT OF PENETRATING WOUNDS OF THE NECK

Management policies for penetrating wounds of the neck vary from manda tory surgical exploration to selective surgical exploration following extensive or minimal imaging investigation. In order to review the tre atment protocol at Sheba Medical Center, Tel Hashomer, Israel, we retr ospectively studied 21 patients who were treated between the years 198 4 and 1989. Thirteen had gunshot injuries and eight had stab wounds. E ight patients had undergone immediate exploration of the neck. Four pa tients had died, but all of these latter patients had evidence for sig nificant bleeding that could have been detected within a short time of admission. On the basis of our findings and previous studies, we conc lude that: presenting features of neck injuries should be differentiat ed into two basic categories: immediately life-threatening and not imm ediately life-threatening. Immediately life-threatening features inclu de overt massive bleeding, expanding hematoma, non-expanding hematoma in the presence of hemodynamic instability, hemomediastinum, hemothora x, and hypovolemic shock. In all of these cases, immediate surgical ex ploration is mandatory. Non-life-threatening features include any sign s of vascular complication in a hemodynamically stable patient, signs of upper aerodigestive tract lesions (when initial treatment has alrea dy relieved respiratory distress) and periphral neurological deficits. These patients should undergo thorough imaging investigations on the basis of which the need for and the nature of possible surgical interv ention can be determined.