Penetrating neck trauma

The workup and management of penetrating neck injuries has changed dramatically. As early as the 1500s, ligation of bleeding vessels was practiced for penetrating neck injuries. This resulted in increased survival, but increased morbidity due to neurovascular deficits. From the Civil War through WWII, most penetrating injuries were managed nonoperatively. This changed after WWII when concern for missed vascular injuries prompted many surgeons to perform immediate surgical exploration for all Zone II injuries. Since the 1990s, improvements in diagnostic imaging have allowed selective neck exploration based on physical exam and the results of imaging studies. Mortality from penetrating neck injuries ranges from 2 to 10 %. Up to 15-20 % of patients have an arterial injury, and tracheolaryngeal injuries occur in 1-7 % of patients. Esophageal injuries are found in 0.9-6.6 % with a mortality rate up to 20 %. The mechanism of injury is important when considering the management of penetrating injuries. Gunshot wounds have a higher incidence of significant injury and therefore require surgery more frequently. A stab wound tract can be difficult to delineate, and the extent of the injury may, therefore, be underestimated.