On-line version ISSN 2078-5151
S. Afr. j. surg. vol.47 n.3 Cape Town Aug. 2009
Selective observational management of penetrating neck injury in Northern Nigeria
F.W.A.C.S., Department of Surgery, Ahmadu Bello University Teaching hospital, Zaria, Nigeria
BACKGROUND: The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution.
METHODS: The study was conducted between 1991 and 2006. Patients whose injuries penetrated platysma were included. Following resuscitation, physical signs were utilised to select patients for exploration or observation. Investigations were based on physical signs which, with details of injured structures, treatments and outcomes, were recorded.
RESULTS: There were 225 patients of whom 209 (93.0%) were men. Their mean age was 28 years. The majority (74.2%) of cases were stab wounds, and the balance (25.8%) were gunshot injuries. In 37.8% and 27.6% of patients, injuries were sustained during armed civilian conflicts and robberies, respectively. Patients with no signs of significant injuries (37.8%) were treated by observation. Overall, 52.4% underwent neck exploration; injuries requiring repair were found in 87.3% of these patients. Physical signs as a basis of detecting significant injury had a sensitivity of 97.2% and specificity of 87.4%. Overall mortality was 4.0%.
CONCLUSION: Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations.
“Full text available only in PDF format”
1. Fogelman M, Stewart R. Penetrating wounds of the neck. Am J Surg 1956; 91: 581-593. [ Links ]
2. Ordog G. Penetrating neck trauma. J Trauma 1987; 27: 543-554. [ Links ]
3. Progmet D, Danic D, Malicic D, Leovic D, Danic A, Katic A. Injuries of the neck: war time and peacetime experiences. Acta Med Croatica 2006; 60: 365-368. [ Links ]
4. Nason RW, Assuras GN, Gray PR, Lipschite J, Burn CM. Penetrating neck injuries: analysis of experience from a Canadian trauma centre. Can J Surg 2001; 44: 122-126. [ Links ]
5. Metzdorff M, Lowe D. Operation or observation for penetrating neck wounds? A retrospective analysis. Am J Surg 1984; 147: 646-649. [ Links ]
6. Stallmeyer MJ, Morales RE, Flanders AE. Imaging of traumatic neurovascular injury. Radiol Clin North Am 2006; 44: 13-39. [ Links ]
7. Pakarinen T, Leppaniemi A, Sihvo E, Hiltunen K, Salo J. Management of cervical stab wounds in low-volume trauma centres: systematic physical examination and low threshold for adjunctive studies or surgical exploration. Injury 2006; 37: 440-447. [ Links ]
8. Sriussdaporn S, Pak-Art R, Tharavej C, Sirichindakul B, Chiamananthapong S. Selective management of penetrating neck injuries based on clinical presentation is safe and practical. Int Surg 2001; 86: 90-93. [ Links ]
9. Insull P, Adams D, Segar A, Ng A, Civil I. Is exploration mandatory in penetrating zone II neck injuries? Aust N Z J Surg 2007; 77: 261-264. [ Links ]
10. Munera F, Soto JA, Placio DM, et al. Penetrating neck injuries: helical CT angiography for initial evaluation. Radiology 2002; 224: 366-372. [ Links ]
11. Inaba K, Munera F, McKenney M, et al. Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injury. J Trauma 2006; 61: 144-149. [ Links ]
12. Adesunkanmi ARK, Akinkuolie AA, Badru OS. A five-year analysis of death in accident and emergency room of a semi-urban hospital. West Afr J Med 2002; 2: 99-104. [ Links ]
13. Roon AJ, Christensen N. Evaluation and treatment of penetrating cervical injuries. J Trauma 1979; 19: 391-397. [ Links ]
14. Demetriades D, Asensio JA, Velmahes G, Thal E. Complex problems in penetrating neck trauma. Surg Clin North Am 1996; 6: 661-683. [ Links ]
15. Merion RM, Harness JK, Ramsburgh SA,Thompson NM. Selective management of penetrating neck trauma cost implications. Arch Surg 1977; 116: 691-696. [ Links ]
16. Demetriades D, Velmahos GG, Aseusio JA. Cervical pharyngoesophageal and laryngotracheal injuries. World J Surg 2001; 25: 1044-1048. [ Links ]
17. Adegboye VO, Brimmo IA, Adebo A. Tracheobroncheal injuries. Niger J Surg 2002; 8: 4-8. [ Links ]
18. Goudy SL, Miller FB, Bumpous JM. Neck crepitance: evaluation and management of suspected upper aero-digestive tract injury. Laryngoscope 2002; 112: 791-795. [ Links ]
19. Campbell FC, Robbs J. Penetrating injuries of the neck: a prospective study of 108 patients. Br J Surg 1980; 67: 582-586. [ Links ]
20. Bell RB, Osborn T, Dierks EJ, Potter BE, Long WB. Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral Maxillofac Surg 2007; 65: 691-705. [ Links ]
21. Rivkind AI, Zvulunov A, Schwartz AJ, Reissman P, Belz M. Penetrating neck trauma: hidden injuries esophagospinal traumatic fistula. J R Coll Surg Edinb 2001; 46: 113-116. [ Links ]
22. Azuaje RE, Jacobson L, Glover J, et al. Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma. Am Surg 2003; 69: 804-807. [ Links ]
23. Ferguson E, Dennis JW, Vu JH, Frykberg ER. Redefining the role of arterial imaging in the management of penetrating zone 3 neck injuries. Vascular 2005; 13: 158-163. [ Links ]
24. Weigelt JA,Thal ER,Synder WH,Fry RE,Meier DE,Kilman WJ.Diagnosis of penetrating cervical esophageal injuries. Am J Surg 1987; 154: 619-622. [ Links ]