Penetrating neck trauma: a review of management strategies and discussion of the 'No Zone' approach.

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  • Additional Information
    • Source:
      Publisher: SAGE Publications in association with Southeastern Surgical Congress Country of Publication: United States NLM ID: 0370522 Publication Model: Print Cited Medium: Internet ISSN: 1555-9823 (Electronic) Linking ISSN: 00031348 NLM ISO Abbreviation: Am Surg Subsets: MEDLINE
    • Publication Information:
      Publication: 2020- : [Thousand Oaks, CA] : SAGE Publications in association with Southeastern Surgical Congress
      Original Publication: Atlanta Ga : Southeastern Surgical Congress
    • Subject Terms:
      Decision Support Techniques* ; Multidetector Computed Tomography* ; Physical Examination*; Neck Injuries/*diagnosis ; Wounds, Penetrating/*diagnosis; Algorithms ; Angiography/methods ; Humans ; Magnetic Resonance Angiography ; Neck Injuries/surgery ; Triage/methods ; Ultrasonography, Doppler, Color ; Wounds, Penetrating/surgery
    • Abstract:
      The evaluation and management of hemodynamically stable patients with penetrating neck injury has evolved considerably over the previous four decades. Algorithms developed in the 1970s focused on anatomic neck "zones" to distinguish triage pathways resulting from the operative constraints associated with very high or very low penetrations. During that era, mandatory endoscopy and angiography for Zone I and III penetrations, or mandatory neck exploration for Zone II injuries, became popularized, the so-called "selective approach." Currently, modern sensitive imaging technology, including computed tomographic angiography (CTA), is widely available. Imaging triage can now accomplish what operative or selective evaluation could not: a safe and noninvasive evaluation of critical neck structures to identify or exclude injury based on trajectory, the key to penetrating injury management. In this review, we discuss the use of CTA in modern screening algorithms introducing a "No Zone" paradigm: an evidence-based method eliminating "neck zone" differentiation during triage and management. We conclude that a comprehensive physical examination, combined with CTA, is adequate for triage to effectively identify or exclude vascular and aerodigestive injury after penetrating neck trauma. Zone-based algorithms lead to an increased reliance on invasive diagnostic modalities (endoscopy and angiography) with their associated risks and to a higher incidence of nontherapeutic neck exploration. Therefore, surgeons evaluating hemodynamically stable patients with penetrating neck injuries should consider departing from antiquated, invasive algorithms in favor of evidence-based screening strategies that use physical examination and CTA.
    • Publication Date:
      Date Created: 20130116 Date Completed: 20130319 Latest Revision: 20200722
    • Publication Date:
      20240829
    • Accession Number:
      10.1177/000313481307900113
    • Accession Number:
      23317595