Penetrating Neck Injury: What’s In and What’s Out?

Roepke, Clare; Benjamin, Elizabeth; Jhun, Paul; Herbert, Mel

doi:10.1016/j.annemergmed.2016.03.039

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…In most cases, zone II injuries are surgically explored because they are more accessible and easy to explore. On the other hand, zone I or III injuries are usually evaluated by several imaging methods prior to surgery, since they are difficult to manage 7,15 . This led to a high rate of negative neck exploration (30-80%) and significantly associated morbidity (50%) 16 .…”

Section: Discussionmentioning

confidence: 99%

“…This led to a high rate of negative neck exploration (30-80%) and significantly associated morbidity (50%) 16 . Although the zoning system of PNI classification was the most commonly used in everyday clinical practice, it is important to emphasize that the external hole often does not correlate with the internal injury 15 .…”

Section: Discussionmentioning

confidence: 99%

“…It is based on thorough clinical examination and additional investigations as a safe and reliable way to exclude clinically significant injuries. Roepke et al 15 recommend that computed tomography angiography should be performed additionally in hemodynamically stable patients who are with no hard signs of injury. The benefits of the SNOM approach have been confirmed with high sensitivity (93-95%) and a negative predictive value of 97% 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…The benefits of the SNOM approach have been confirmed with high sensitivity (93-95%) and a negative predictive value of 97% 17,18 . On the other hand, in hemodynamically unstable patients with hemoptysis, hematemesis, arterial bleeding, rapidly expanding hematoma, subcutaneous emphysema, hoarseness or painful swallowing, a prompt evaluation under anesthesia that might include laryngoscopy, esophagoscopy, bronchoscopy or even surgical exploration is recommended [5][6][7][8]15 .…”

Section: Discussionmentioning

confidence: 99%

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Penetrating neck injury with consequential thoracic complications managed with use of video-assisted thoracoscopic surgery: A case report

et al. 2020

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Introduction. Penetrating injuries of the neck are potentially life-threatening conditions. They can cause injuries of larynx, trachea, esophagus and major blood vessels in this area. Case report. The patient was a 28-year-old male who was stabbed with broken glass penetrating the front side of the base of his neck. The patient had dyspnea and the wound was inflicted the night before admission to hospital. An otorhinolaryngologist found a stab wound in the region of the left basis of the neck. The wound was 2 cm long with no signs of bleeding and deep injuries of the anatomical structures of the neck. However, since left hemopneumothorax was clinically and radiologically apparent, drainage of the thorax was performed upon admission to the intensive care unit. Initially, 400 mL of hemorrhagic effusion was evacuated. However, 24 hours later the patient became hemodynamically unstable. It was an indication for videoassisted thoracoscopy (VATS). Therefore, VATS was used as a diagnostic method in order to determine the nature of the injury. Intraoperatively, we treated a laceration of pleuropulmonary adhesion which was continuously bleeding from the apex of the thoracic cavity. As a result, adequate surgical hemostasis was achieved. Furthermore, during the three-week postoperative period, thoracic tubes were placed due to the prolonged air leakage. A thoracic tube was placed laterally along with another one which was placed in intercostal space higher. After total reexpansion of the left lung, thoracic tubes were extracted, and the patient was discharged. Conclusion. Nowadays, VATS has become a highly important ultimate treatment of thoracic trauma. This minimally invasive method allows us to verify injury type and localization, to resolve it and further to follow-up evaluation of pathological changes in the lungs, pericardium, mediastinum, pleura and thoracic wall. In the case of stab wounds in the cervical region, any injuries of the lungs and pleura must be taken into consideration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Penetrating neck injury with consequential thoracic complications managed with use of video-assisted thoracoscopic surgery: A case report

et al. 2020

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“…Routine neck exploration in HSPs increases the frequency of unneeded surgeries, iatrogenic injuries, hospital stay, and complications (18)(19)(20). Hemodynamic stability does not exclude injury to underlying structures.…”

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confidence: 99%

Effectiveness of No-Zone Approach for Management of Isolated Penetrating Neck Injuries Among Hemodynamically Stable Patients. A Longitudinal Retrospective Study.

Hassanein

Hazem

Ahmad

et al. 2020

Preprint

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Background: Routine neck exploration for isolated penetrating neck injuries (PNIs) in hemodynamically stable patients increases the frequency of nontherapeutic surgeries, and complications. Current management protocol involves the no zone approach which uses physical examination and computerized tomographic angiography to guide treatment plans. This work aimed to study the effectiveness and reliability of no-zone approach for management of isolated PNIs in hemodynamically stable patients. Methods: cases of isolated PNIs in hemodynamically stable patients were managed using no zone approach. Detected injuries were managed accordingly. Results: This study included 106 patients. 34.9% of patients were managed conservatively while surgery was done at 65.09%. Vascular management was done in 40.57%, laryngotracheal repair in 29.2%, tracheostomy in 17%, pharyngeal repair in 7.55%, esophageal repair in 6.6%, and accessory nerve repair in 2.83%. Complications occurred in 16.04% of cases in the form of vascular complications (7.5%), respiratory complications (5.7%), pharyngoesophageal complications (1.9%), infections (12.3%), and neurological complications (7.5%). The survivors were 91.5% while deaths were 8.5%. Conclusion: The no-zone approach offers the ideal management for isolated PNIs in hemodynamically stable patients. It is advantageous over traditional approaches. Further studies are required to augment the evidence for its use as the gold standard management for such cases. Trial registration: the study was retrospectively registered at research registry with Research Registry UIN researchregistry5385 on February 26, 2020. Keywords: no zone approach, isolated penetrating neck injuries, hemodynamically stable patients, vascular injuries, laryngotracheal injury.

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