Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2016

Open Access 01-12-2016 | Research article

Safety in selective surgical exploration in penetrating neck trauma

Authors: Frederico Teixeira, Carlos Augusto Metidieri Menegozzo, Sérgio Dias do Couto Netto, Renato S. Poggeti, Francisco de Sales Collet e Silva, Dario Birolini, Celso de Oliveira Bernini, Edivaldo Massazo Utiyama

Published in: World Journal of Emergency Surgery | Issue 1/2016

Login to get access

Abstract

Background

Selective management of penetrating neck injuries has been considered the standard of care with minimal risks to patient safety. In a previous non-randomized prospective study conducted at our center, selective management proved to be safe and reduced unnecessary exploratory cervicotomies. In the present study, the role of clinical examination and selective diagnostic tests were assessed by reviewing demographic and clinical data. A comparison of results between two groups (mandatory surgical exploration versus selective surgical exploration) was made to check the safety of selective management in terms of the rates of morbidity and mortality.

Methods

A retrospective analysis at the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo was performed by a chart review of our trauma registry, identifying 161 penetrating neck trauma victims.

Results

Of the 161 patients, 81.6 % were stabbed and 18.4 % had gunshot injuries. Stratifying the wound entry points by neck zones, we observed that zone I was penetrated in 32.8 %, zone II in 44.1 % and zone III in 23.1 % of all the cases. Thirty one patients (19.2 %) had immediate surgical exploration, which had a mean length of stay of 6 days, a complication rate of 12.9 % and a mortality rate of 9.4 %. Of the 130 who underwent selective surgical exploration 34 (26.1 %) required operative procedures after careful physical examination and diagnostic testing based on clinical indications. The mean length of stay for the selective surgical exploration group was 2 days with a complication rate of 17.6 % with no mortality, and virtually all of them were related to associated injuries in distant body segment. No statistical significance was found comparing mortality and complication rates between the two groups. Selective approach avoided 59 % of unnecessary exploratory cervicotomies.

Conclusion

Careful evaluation of asymptomatic and stable patients with minor signs of injury can safely avoid unnecessary neck explorations with low rates of morbidity. This should be the standard management of such patients.
Literature
1.
Biffl WL, Moore EE, Rehse DH, Offner PJ, Franciose RJ, Burch JM. Selective management of penetrating neck trauma based on cervical level of injury. Am J Surg. 1997;174:678–82.CrossRefPubMed
2.
Fox CJ, Gillespie DL, Weber MA, Cox MW, Hawksworth JS, Cryer CM, Rich NM, O'Donnell SD. Delayed evaluation of combat-related penetrating neck trauma. J Vasc Surg. 2006;44:86–93.CrossRefPubMed
3.
Burgess CA, Dale OT, Almeyda R, Corbridge RJ. An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol. 2012;37:44–52.CrossRefPubMed
4.
Thoma M, Navsaria PH, Edu S, Nicol AJ. Analysis of 203 patients with penetrating neck injuries. World J Surg. 2008;32(12):2716–23.CrossRefPubMed
5.
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):122–6.PubMedPubMedCentral
6.
Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R, et al. Western Trauma association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75(6):936–40.CrossRefPubMed
7.
Lourencao JL, Nahas SC, Margarido NF, Rodrigues Junior AJ, Birolini D. Penetrating Trauma to the Neck: prospective study of 53 cases. Rev Hosp Clin Fac Med Sao Paulo. 1998;53(5):234–41.PubMed
8.
Demetriades D, Charalambides D, Lakhoo M. Physical examination and selective conservative management in patients with penetrating injuries of the neck. Br J Surg. 1993;80:1534–6.CrossRefPubMed
9.
Demetriades D, Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, Velmahos G, Weaver F, Yellin A. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg. 1997;21(1):41–7. discussion 47–8.CrossRefPubMed
10.
Roon AJ, Christensen N. Evaluation and treatment of penetrating cervical injuries. J Trauma. 1979;19:391–7.CrossRefPubMed
11.
Gilroy D, Lakhoo M, Charalambides D, Demetriades D. Control of life-threatening haemorrhage from the neck: a new indication for balloon tamponade. Injury. 1992;23(8):557–9.CrossRefPubMed
12.
Bagheri SC, Khan HA, Bell RB. Penetrating neck injuries. Oral Maxillofac Surg Clin North Am. 2008;20(3):393-414
13.
Bigger IA, Lippert KM. Arteriovenous fistula involving common carotid artery and internal jugular vein. Surgery. 1937;2:555.
14.
15.
16.
17.
Mooro A. A case of arteriovenous aneurysm of the neck. Lancet. 1923;2:1186.CrossRef
18.
Markey JC, Hines JL, Nance FC. Penetrating neck wounds: a review of 218 cases. Am J Surg. 1975;130:416–20.CrossRef
19.
Insull P, Adams D, Segar A, Ng A, Civil I. Is exploration mandatory in penetrating zone II neck injuries. ANZ J Surg. 2007;77:261–4.CrossRefPubMed
20.
Inaba K, Munera F, McKenney M, Rivas L, Moya M, Bahouth H, Cohn S. Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injuries. J Trauma. 2006;61:144–9.CrossRefPubMed
21.
Schroeder JW, Baskaran V, Aygun N. Imaging of traumatic arterial injuries in the neck with an emphasis on CTA. Emerg Radiol. 2010;17:109–22.CrossRefPubMed
22.
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: a prospective multicenter study. J Trauma Acute Care Surg. 2012;72:576–83. discussion 583Y574; quiz 803Y804.CrossRefPubMed
23.
Sekharan J, Dennis JW, Veldenz HC, Miranda F, Frykberg ER. Continued experience with physical examination alone for evaluation and management of penetrating zone 2 neck injuries: results of 145 cases. J Vasc Surg. 2000;32:483–9.CrossRefPubMed
24.
Tisherman SA, Bokhari F, Collier B, Cumming J, Ebert J, Holevar M, Kurek S, Leon S, Rhee P. Clinical practice guideline: penetrating zone II neck trauma. J Trauma. 2008;64(5):1392–405.CrossRefPubMed
25.
O’Brien PJ, Cox MW. A modern approach to cervical vascular trauma. Perspect Vasc Surg Endovasc Ther. 2011;23(2):90–7.CrossRefPubMed
26.
Weigelt JA, Thal ER, Snyder 3rd WH, Fry RE, Meier DE, Kilman WJ. Diagnosis of penetrating cervical esophageal injuries. Am J Surg. 1987;154(6):619–22.CrossRefPubMed
27.
Wood J, Fabian TC, Mangiante EC. Penetrating neck injuries: recommendations for selective management. J Trauma. 1989;29(5):602–5.CrossRefPubMed
28.
Ngakane H, Muckart DJ, Luvuno FM. Penetrating visceral injuries of the neck: results of a conservative management policy. Br J Surg. 1990;77(8):908–10.CrossRefPubMed
29.
Srinivasan R, Haywood T, Horwitz B, Buckman RF, Fisher RS, Krevsky B. Role of flexible endoscopy in the evaluation of possible esophageal trauma after penetrating injuries. Am J Gastroenterol. 2000;95(7):1725–9.CrossRefPubMed
30.
31.
Madsen AS, Laing GL, Bruce JL, Oosthuizen GV, Clarke DL. An audit of penetrating neck injuries in a South African Trauma service. Injury. 2016;47(1):64–9.CrossRefPubMed
32.
Harris R, Olding C, Lacey C, Bentley R, Schulte KM, Lewis D, Kandasamy N, Oakley R. Changing incidence and management of penetrationg neck injuries in the South East London Trauma Centre. Ann R Coll Surg Engl. 2012;94:240–4.CrossRefPubMedPubMedCentral
33.
Mohammed GS, Pillay WR, Barker P, Robbs JV. The role of clinical examination in excluding vascular injury in haemodynamically stable patients with gunshot wounds to the neck. A prospective study of 59 patients. Eur J Vasc Endovasc Surg. 2004;28:425–30.CrossRefPubMed
34.
Eddy VA. Is routine angiography mandatory for penetrating injury to zone 1 of the neck? Zone 1 penetrating neck injury study group. J Trauma. 2000;48:208–13.CrossRefPubMed
35.
Ferguson E, Dennis JW, Vu JH, Frykberg ER. Redefining the role of arterial imaging in the management of penetrating zone 3 neck injuries. Vascular. 2005;13:158–63.CrossRefPubMed
36.
Bishara RA, Pasch AR, Douglas DD, Schuler JJ, Lim LT, Flanigan DP. The necessity of mandatory exploration of penetrating zone II neck injuries. Surgery. 1986;100:655–60.PubMed
37.
Golueke PJ, Goldstein AS, Sclafani SJ, Mitchell WG, Shaftan GW. Routine versus selective exploration of penetrating neck injuries: a randomized prospective study. J Trauma. 1984;24:1010–4.CrossRefPubMed
38.
Pakarinen TK, Leppäniemi A, Sihvo E, Hiltunen KM, Salo J. Management of cervical stab wounds in low volume trauma centres: Systematic physical examination and low threshold for adjunctive studies, or surgical exploration. Injury. 2006;37:440–7.CrossRefPubMed
39.
Apffelstaedt JP, Mtiller R. Results of mandatory exploration for penetrating neck trauma. World J Surg. 1994;18:917–20.CrossRefPubMed
40.
Meyer JP, Barrett JA, Schuler JJ, Flanigan P. Mandatory vs selective exploration for penetrating neck trauma. Arch Surg. 1987;122(5):592–7.CrossRefPubMed
41.
Noyes LD, McSwain NE, Markowitz IP. Panendoscopy with arteriography versus mandatory exploration of penetrating wounds of the neck. Ann Surg. 1986;204(1):21–31.CrossRefPubMedPubMedCentral
42.
Soliman A, Ahmad SM, Roy D. The role of aerodigestive tract endoscopy in penetrating neck trauma. Laryngoscope. 2014;124 Suppl 7:S1–9.CrossRefPubMed
43.
Van Waes OJ, Cheriex KC, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg. 2012;99 Suppl 1:149–54.CrossRefPubMed
44.
Demetriades D, Theodorou D, Cornwell 3rd E, Weaver F, Yellin A, Velmahos G, Berne TV. Penetrating injuries of the neck in patients in stable condition. Physical examination, angiography, or color flow doppler imaging. Arch Surg. 1995;130(9):971–5.CrossRefPubMed
45.
Zaidi SMH, Ahmad R. Penetrating neck trauma: a case for conservative approach. Am J Otolaryngol. 2011;32:591–6.CrossRef
Metadata
Title
Safety in selective surgical exploration in penetrating neck trauma
Authors
Frederico Teixeira
Carlos Augusto Metidieri Menegozzo
Sérgio Dias do Couto Netto
Renato S. Poggeti
Francisco de Sales Collet e Silva
Dario Birolini
Celso de Oliveira Bernini
Edivaldo Massazo Utiyama
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2016
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-016-0091-4

Other articles of this Issue 1/2016

World Journal of Emergency Surgery 1/2016 Go to the issue

Research article

Emergency right colectomy: which strategy when primary anastomosis is not feasible?

Reviewer acknowledgement

World Journal of Emergency Surgery reviewer acknowledgement 2015

Research article

Surgeon agreement at the time of handover, a prospective cohort study

Research article

Plasma calprotectin level: usage in distinction of uncomplicated from complicated acute appendicitis

Research article

The learning curve of single-port laparoscopic appendectomy performed by emergent operation

Research article

Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography