Background: The management of penetrating neck trauma (PNT) evolved from a policy of mandatory exploration to one of selective non-operative management (SNOM) based on clinical examination, and the liberal use of Computed Tomography Angiography (CTA) irrespective of the zone of injury for those patients who are stable on presentation.
Methods: A retrospective audit of patients with penetrating neck injuries managed at Chris Hani Baragwanath Academic Hospital (CHBAH) Trauma Unit, from 2010 to 2015 was conducted. Statistical analysis was performed for all collected variables. A p-value of ≤ 0.05 was considered statistically significant.
Results: The results of treatment of 594 patients were reviewed. There was a predominance of young males (93.4%) with a median age of 28 years (IQR 18-67) presenting with injuries in zone 2, left side of the neck, commonly due to stab wounds (89.3%). Immediate surgical exploration was needed in 145(24.4%), while the remaining (75.4%) were investigated with CTA. CTA showed a sensitivity and specificity of over 90% for vascular injuries and more than 80% for aerodigestive injuries. Major vascular injuries were the most common surgical finding. The overall negative exploration rate was 6%, and the mortality 2.5%.
Conclusions: Our unit’s SNOM protocol relies on liberal CTA use. Despite the obvious limitations of a retrospective study our results showed an acceptable negative and non-therapeutic exploration rate and a low incidence of complications and mortality.
Siau RTK, Moore A, Ahmed T, Lee MSW and Tostevin P. Management of penetrating neck injuries at a London trauma centre. Eur Arch Otorhinolaryngeal. 2013; 270: 2123-2128.
Shah K, Lee J, Medlej K and Weingart, S. eds.. Trauma. In: Practical emergency resuscitation and critical care . Cambridge: Cambridge Univeristy press, pp. 41-114 doi:10.1017/CB09781139523936.007. 2013
Prichayudh S, Choadrachata-anun J, Sriussadaporn S, Pak-art R, Sriussadaporn S, Kritayakirana K and Samorn P. Selective management of penetrating neck injuries using 'no zone' approach. Injury, Int J Care Injured. 2015; 46: 1720-1725.
Shiroff AM, Gale SC, Martin ND, Marchalik D, Petrov D, Ahmed HM, Rotondo MF and Gracias VH. Penetrating neck trauma: A review of management strategies and discussion of the 'no zone' approach. The American Surgeon. 2013; 79: 23-29.
Low GMI, Inaba K, Chouliaras K, Branco B, Lam L, Benjamin E, Menaker J and Demetriades D. The use of the anatomic 'zones' of the neck in the assessment of penetrating neck injury. The American Surgeon. 2014; 80: 970-974.
Norman R, Matzopoulos R, Groenewald P and Bradshaw D. The high burden of injuries in South Africa. Bulletin of the World Health Organization. 2007; 85: 695-702.
Ghnnam W, Al-Mastour A and Bazeed M. Penetrating neck trauma in a level II trauma hospital, Saudi Arabia. ISRN Emergency Medicine. 2012; article ID 672948[doi ID 5402/2012/672948], pp. 1-6.
Mahmoodie M, Sanei B, Moazeni-Bistgani M and Namgar M. Penetrating neck trauma: review of 192 cases. Arch Trauma Res. 2010; 1: 14-18.
Kasbekar AV, Combellack EJ, Derbyshire SG and Swift AC. Penetrating neck trauma and the need for surgical exploration: six-year experience within a regional trauma centre. The Journal of Laryngology and Otology. 201; 131: 8-12.
Bordoni LS, de Assis AL, Silva GA, Drumond LGS, De Mendonca MLF and Bordoni PHC. Neck Trauma deaths in Brazil: Review of 541 cases. Brazilian Journal of Forensic Sciences, Medical Law and Bioethics. 2016; 5: 441-457.
Diaz-Martinez J, Marin JC and Gruezo RB. Review of the penetrating neck injuries in 279 patients, analysis of a single institution. Journal of General Surgery. 2019; 3 : 1-4.
Sethi RKV, Kozin ED, Fagenholz PJ, Lee DJ, Shrime MG, and Gray ST. Epidemiological Survey of Head and Neck Injuries and Trauma in the United States. Otolaryngol Head Neck Surg. 2014; 151: 776–784.
Madsen AS, Bruce JL, Oosthuizen GV, Bekker W, Laing GL, Clarke DL. The selective non-operative management of penetrating cervical venous injuries is safe and effective. World J Surg 2018;42(10):3202-3209 doi.10.1007/s00268-018-4595-9
Madsen A, Laing GL, Bruce JL, Oosthuizen GV and Clarke DL. An audit of penetrating neck injuries in a South African trauma service. Injury. 2016; 47: 64-69.
Madsen AS, Laing G, Bruce J, and Clarke D. A comparative audit of gunshot wounds and stab wounds to the neck in a South African metropolitan trauma service. Ann R Coll Surg Engl. 2016; 98: 488-495.
Madsen AS,Oosthuizen G, Laing GL, Bruce JL and Clarke DL. The role of computed tomography angiography in the detection of aerodigestive tract injury following penetrating neck injury. Journal of Surgical Research. 2016; 205: 490-498.
Thoma M, Navsaria P, Edu S and Nicol A. Analysis of 203 patients with penetrating neck injuries. World J Surg. 2008; 32: 2716-2723.
van Waes OJ, Cheriex KCAL, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg 2012;99Suppl 1:149-154 doi.10.1002/bjs.7733
Navsaria P, Omoshoro-Jones J. Nicol A. An analysis of 32 surgically managed penetrating carotid injuries. Eur J Vasc Endovasc Surg 2002;24(4):349-355 doi.10.1053/ejvs.2002.1736
Kong V, Ko J, Cheung C, Lee B, Leow P, Thirayan V, et al. Foley Catheter Balloon Tamponade for Actively Bleeding Wounds Following Penetrating Neck Injury is an Effective Technique for Controlling Non-Compressible Junctional External Haemorrhage World J Surg. 2022 May;46(5):1067-1075. doi: 10.1007/s00268-022-06474-4.
Scriba M, McPherson D, Edu S, Nicol A, Navsaria P. An Update on Foley Catheter Balloon Tamponade for Penetrating Neck Injuries. World J Surg. 2020 Aug;44(8):2647-2655. doi: 10.1007/s00268-020-05497-z.
Apffelstaedt JP, Müller R. Results of mandatory exploration for penetrating neck trauma. World J Surg 1994;18:917-920
Narrod JA, Moore EE. Selective management of penetrating neck injuries. A prospective study. Arch Surg 1984;119(5):574-578 doi.10.1001/archsurg.1984.01390170070014
Ibraheem K, Wong S, Smith A, Guidry C, McGrew P, et al. Computed tomography angiography in the “no-zone” approach era for penetrating neck trauma: A systematic review. J Trauma Acute Care Surg 2020;89(6)1233-1238 doi.1097/TA.0000000000002919
Paladino L, Baron BJ, Shan G, Sinert R. Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review Acad Emerg Med 2021;28(10):1160-1172 doi.10.1111/acem.14298
Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW at al. Western Trauma Association Critical Decision in Trauma: Penetrating neck trauma J Trauma Acute Care Surg 2013;75(6):936-940 doi.10.1097/TA.0b.013e.31829e20e3
Inaba K, Branco BC, Menaker J, Scalea TM, Crane S, DuBose JJ, Tung L, Reddy S, Demetriades D. Evaluation of multidetector computed tomography for penetrating neck injury, J Trauma Acute Care Surg 2012;72(3):576-584 doi: 10.1097/TA.0b013e31824badf7
Nason RW, Assuras GN, Gray PR, Lipschitz J, Burns CM. Penetrating neck injuries: analysis of experience from a Canadian trauma centre. Can J Surg. 2001;44(2):122-126.
Asensio JA, Valenziano CP, Falcone RE et al. Management of penetrating neck injuries: The controversy surrounding zone II injuries. Surg Clin North Am 1991;71:267-296
Biffl WL, Moore EE, Dagmar H, Offner PJ, Frnaciose RJ, Burch JM. Selective management of penetrating neck trauma based on cervical level of injury. Am J Surg 1997;174:678-682
Brennan J. Head and neck trauma in Iraq and Afghanistan: different war, different surgery, lessons learned. Laryngoscope 2013;123:2411-2417
Brennan J, Lopez M, Gibbon MD, Hayes D, Faulkner J, Dorlac WC, Barton C. penetrating neck trauma in operation Iraqi freedom. Otolaryngology Head Neck Surgery 2011;144(2):180-185
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.