PHYSICAL-EXAMINATION AND ARTERIOGRAPHY IN PATIENTS WITH PENETRATING ZONE-II NECK WOUNDS

Objective: To review the management of patients with penetrating zone II neck wounds to discern the value of physical examination and proxim ity arteriography for predicting arterial injury. Design: A retrospect ive chart review of 178 patients treated for penetrating wounds to the neck. Setting: A level I trauma facility in Dallas. Tex. Patients: Al l patients seen from 1987 to 1991 with platysma penetration in zone II of the neck. Intervention: Physical examination, arteriography, and s urgical exploration were used to identify patients with arterial injur ies in the neck after penetrating trauma. Main Outcome Measures: To id entify the presence or absence of an arterial injury. Results: Negativ e findings on physical examination ruled out an arterial injury in 99% of all patients. Patients with any sign of arterial injury had a 26% incidence of arterial injury confirmed at operation. Of 71 arteriogram s in patients without signs or symptoms of arterial injury, only one h ad an arterial injury requiring operative intervention. Conclusions: F indings on physical examination are good predictors of arterial injury in patients with penetrating neck wounds and can exclude injury in ov er 99% of patients. Arteriography is a sensitive test but has a very l ow yield (1.4%). These findings question whether the current practice of mandatory neck exploration or proximity arteriography is necessary for patients without signs or symptoms of injury who have penetrating wounds of the neck.