Routine versus selective exploration of penetrating neck injuries: a randomized prospective study

In an effort to settle the controversy regarding the optimal management of penetrating trauma to the neck, a randomized prospective study was conducted in which 160 patients with penetrating neck injuries admitted to Kings County Hospital between 1977 and 1982 were placed, by protocol, into two groups. Group A patients were explored routinely for all injuries to the neck violating the platysma muscle. Group B patients were managed selectively with operation based on clinical or radiographic evidence of major vascular, visceral, or airway injury. Data were collected retrospectively. Length of hospital stay, morbidity, and mortality were compared between groups A and B, as well as between patients explored or not, and no statistical difference was noted. Since there is no clear advantage to either routine or selective exploration in the management of penetrating neck wounds, we conclude that surgeons should base their treatment on their own experience, house staff and nursing support, and radiologic and operating room availability.