Abstract

The optimum management strategy of penetrating neck injuries is a controversial issue. The initial trend was a mandatory exploration of every PNI once the platysma is violated. It changed over time into a selective approach with surgery done to patients with overt clinical features and/or abnormal investigations. Objective: This study was designed to discuss and resolve the ongoing controversy regarding the optimum strategy for management of the neck injuries in our centers and discussing the results with the other regional and national studies. Methods: from Jan. 2007 to Oct. 2015, a retrospective study done on 95 patients, with neck injuries whom admitted to the thoracic surgical ward at the Al-Sader teaching hospital in Al- Basra city, the basic data collected including age, sex, occupation, type of injury whether penetrating or blunt trauma to the neck, zone of the neck injured and the structures were injured and the type of vascular injury and repair done were studied in this study. Results: Out of 9787 patients whom admitted to the thoracic and vascular word in the Al Sader teaching hospital, 95 patients with neck injuries were included in this study, all of them were male, with the majority between 20 – 40 years old (64%), most of them were self-employed (75%), 94 % were suffering from Penetrating neck injuries while 6% had blunt neck trauma, most of them were wounded at zone II (61%), next is zone I (18.94%), while the least is zone III (9.47 %), (54.73%) of the patients had associated injuries, and most of them were associated with chest injuries (18.94%), next to them the head and upper limbs (9.47%) each. In our study, we adopted the selective approach for neck exploration, where only 34 patients ( 35.79%) out of 95 patients had been under went mandatory exploration, those whom presented with severe bleeding, expanding hematoma, or with signs and symptoms of airodigestive injuries, 10 patients of them had been explored for arterial bleeding, and 5 patients underwent venous repair, and 5 patients had been explored for airodigestive injuries, the other patients subjected simple venous ligation and simple wounds suturing and closure, while 64.21% treated conservatively. Finally, the outcome of the patients was relatively good, were Sixty-eight patients (71.58%) out of 95 patients recovered completely and discharged home, 5 patients (5.26%) developed post-operative neurological complications, in the form of CVA, with mortality rate only 2 patients (2.1%) died, both of them under went surgical exploration Conclusion: It is not mandatory to explore all the cases of penetrating neck injury because the majority of cases in many studies can be managed conservatively, so the notion of treating the platysma like a peritoneum need to be revised. Meticulous physical examination is the most important triage tool for selecting cases which need exploration from those who can be observed, yet in few situations, the Invasive investigations like angiography, bronchoscopy, and esophagogram, need to be used selectively based on the physical examination in the cases in which the patterns of injury suggest a concealed damage. Having guidelines in approaching penetrating neck injury minimizes the rate of unnecessary exploration and the possibility of missing an injury.

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