Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach

Author:

Madsen A S1ORCID,Bruce J L1,Oosthuizen G V1,Bekker W1,Smith M1,Manchev V1,Laing G L1,Clarke D L12

Affiliation:

1. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Pietermaritzburg, KwaZulu-Natal, South Africa

2. Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa

Abstract

Abstract Background Many current protocols for managing penetrating neck injuries (PNIs) still suggest zonal approaches. This study was undertaken to determine the correlation between the zone of the external wound and the level of the internal injury, and to verify whether a ‘no-zone’ approach to PNI is valid. Methods Patients admitted with a PNI to a tertiary trauma care centre between January 2011 and May 2018 were identified from a trauma database. Those with confirmed injury to the vascular system or an aerodigestive tract injury (ADTI) were included in the study. The medical records of each patient were reviewed with regard to the zone of the external wound and the level of internal injury, and the findings were compared. Results In the period under review, 1075 patients were treated for a PNI. Of these, 298 (27·7 per cent) had a confirmed vascular injury or ADTI and were included in the cohort. In 176 patients (59·1 per cent) the site of the internal injury was in the same zone as the external wound. In a further 70 patients (23·5 per cent) there was no correlation between the site of the internal injury and the external wound, and in the remaining 52 patients (17·4 per cent) the correlation could not be determined. In this cohort, all clinically assessable patients with significant injuries had either physical signs suggestive of injury or deep surgical emphysema on radiological examination. Conclusion An approach to PNI based on zones is questionable, and this study supports a no-zone approach based on imaging guided by clinical examination.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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1. Outcomes of penetrating carotid artery injuries: A South African multicentre study;World Journal of Surgery;2024-06-23

2. Diagnostic approach to penetrating neck trauma: What you need to know;Journal of Trauma and Acute Care Surgery;2024-03-25

3. ‘No zone’ approach in the management of penetrating neck injuries – an Australian Tertiary Trauma Centre experience;ANZ Journal of Surgery;2024-03-25

4. Blunt and Penetrating Airway Trauma;Emergency Medicine Clinics of North America;2023-02

5. Injuries of the Neck;Soft Tissue Injuries of the Head and Neck;2023

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