Management of penetrating neck injuries

In 44 patients neck wounds penetrating the platysma were evaluated over a 5-year period. Twenty-one patients were admitted and observed; 22 patients were explored immediately. One was dead upon arrival in the emergency room. The decision to explore was based upon initial clinical evaluation using criteria of unstable vital signs, bleeding, hematoma, subcutaneous emphysema, respiratory distress, or neurologic deficits. Of the 21 patients selected for observation, none had complications or required later surgery. There was a negative exploration rate of 23%. Had all patients been explored, the negative exploration rate would have been 60%. We conclude that selective exploration, based upon careful clinical evaluation, is both safe and reasonable in cases of penetrating neck trauma.