Evaluation and treatment of penetrating cervical injuries

Because the serious nature of penetrating cervical injuries may not be readily apparent on initial evaluation, and since delay in treatment can result in serious complications, a systematic method of evaluation and routine exploration has been employed in treating these injuries. One hundred eighty-nine patients, 49 with gunshot wounds and 140 with stab wounds, were treated in this series. Arteriography was performed in 62 patients (33%) to detect vascular injuries and to aid in the planning of the operative approach in patients with high or low neck wounds. Arteriography was 98% accurate and changed the operative approach in 29% of the positive studies. Of the 154 explorations 72 were positive (47%). There were no deaths and only four complications in the group with negative explorations. The mortality rate for the series was 2.6%. We believe that angiography in selected patients and routine exploration of wounds penetrating the platysma can minimize morbidity and mortality in these injuries.