Penetrating Neck Trauma

Historical Perspective

Penetrating wounds to the neck are common in civilian trauma centers, with appreciably high morbidity and mortality depending on the mechanism of injury (gunshot wounds vs. stab wounds), the type of injury (vascular, aerodigestive), and the timeliness in diagnosis and management of significant neck injury.4Y6 The management of penetrating neck injury is dependent on the anatomic level of the injury.5 The specific anatomic borders, which define the zones of penetrating neck injury, have varied using either the cricoid cartilage or level of clavicles to differentiate Zone I from Zone II injury, which is thought to represent a minor modification of no real clinical significance (Table 1).7Y9 For the current algorithm, the original zones using the clavicles to demarcate Zone I from Zone II will be used, with the posterior border of the sternocleidomastoid demarcating the anterior and posterior neck. During the past two decades, the evaluation and management of penetrating neck injuries have significantly evolved, moving from mandatory neck exploration of Zone II injuries and the attributable high negative exploration rate toward expectant and selective operative management with greater use of computed tomographic imagingYbased assessment.10Y15