[Penetrating trauma of the neck: prospective study of 53 cases]

The treatment of penetrating injuries of the neck is still controversial nowadays, especially when there is doubt concerning the existence of any anatomic structure lesion. The delay to indicate surgical cervical exploration may predispose the patient to have serious sequels when the esophagus or the trachea are injured. The infection which may occur in this eventuality progresses rapidly to the mediastinum, determining the patient's death. The purpose of this work was to identify and to analyze the parameters which suggest the best treatment indicated for patients with penetrating injuries of the neck. This is a non-randomized prospective study which gathered 53 patients, victims of penetrating wounds of the neck, treated at the Emergency Surgical Service of the Hospital das Clínicas, University of São Paulo School of Medicine, during a three-year period, starting in October, 1990. All the patients were evaluated by the surgical team on call who elected the selective exploration approach for the cases that did not present clear evidence of injuries in the cervical structures nor hemodynamic alterations. For the fifteen carriers of evident injuries, immediate surgical exploration was the treatment adopted. All the patients had epidemiologic data, evaluation results, hospitalization period, complications, morbidity and mortality rates, besides trauma indexes, collected. For patients whose clinical observation was allowed, endoscopic studies were also performed and compared. In order to evaluate variable correlations, statistical analysis were performed using Q square test, Student test and Z statistics, which leaded to the following conclusions: 1. Penetrating wounds of the neck were most frequent in white people aged from 20 to 30 years. They were mostly located in the right side of cervical zone II and were caused by gunshot. 2. Trauma indexes correlated with patients' clinical evolution. 3. In cases when there was doubt about the effective presence of injuries, complementary digestive and respiratory evaluations were indicated. These exams contributed for reducing the rate of unnecessary surgical explorations.