Penetrating injuries of the neck: selective management evolving.

Since 1990, a selective management algorithm has been used in our Trauma Center to treat 91 patients with penetrating neck injuries. Group A (n = 37) sustained zone I, zone III, or multiple-zone injuries; Group B (n = 54) sustained zone II injuries [most (55, 66.4%) from gunshot or shotgun wounds]. Nineteen Group A and 21 Group B patients required mandatory neck exploration. Vascular or aerodigestive tract injuries were found and adequately repaired in 15 Group A and 11 Group B patients. The superficial wounds of three Group A and seven Group B patients were closed, and the patients were observed for 24 hours. The remaining 15 Group A and 24 Group B patients underwent routine angiogram, arbitrary barium swallow, and, if necessary, esophagoscopy. Two of these Group B patients required surgery for common carotid artery injuries. One patient died 4 months later because of missed vertebral artery pseudoaneurysm. Overall mortality and complication rates were 6 and 1 per cent. Unnecessary exploration was avoided in 52 per cent of cases regardless of the location of the wound. Mortality and morbidity rates were acceptable. Patients with penetrating neck injuries could be safely managed selectively regardless of the injury zone.