Penetrating Neck Trauma
Penetrating neck trauma (PNT), generally a result of a gunshot or stab wound to the neck, makes up 5–10% of traumatic injuries in adults. Key structures located in the neck, such as the carotid arteries, jugular veins, and aerodigestive tract, make this a high-risk injury. Patients with PNT require immediate transport to a trauma center due to the risk for airway compromise and/or significant vascular damage. It is important to note that impaling objects should not be removed in the field, due to potential for hemorrhage or further structural damage. Upon arrival to a trauma center, surgery should be consulted for all patients with PNT.
Historically, mandatory exploration of the neck was common in the management of PNT. With the evolution of CT angiography capabilities, the necessity for operative exploration has decreased. However, the use of a zone-based approach based on the three anatomical zones of the neck continues to be a source of debate among trauma surgeons. In the following algorithm, we recommend a zone-based approach, constructed on current evidence-based guidelines from the Western Trauma Association (WTA) and Eastern Association for the Surgery of Trauma (EAST). While our algorithm provides a reasonable approach to the management of these patients, clinical judgment based on each individual patient should always supersede any guidelines.
KeywordsPenetrating neck trauma Penetrating trauma Neck trauma Neck wounds Airway trauma Vascular neck trauma Esophageal trauma Carotid injury
- 1.American College of Surgeons Committee on Trauma. Advanced trauma life support for doctors. 8th ed. Chicago: American College of Surgeons; 2012.Google Scholar