Transcervical gunshot injuries: mandatory operation is not necessary

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Surgical Oncology

Background:

• Transcervical gunshot wounds often involve vital structures, leading to recommendations for mandatory surgical exploration.
• This prospective study evaluates the clinical presentation, diagnostic methods, and surgical necessity for patients with transcervical gunshot injuries.

Purpose of the Study:

• To investigate the clinical presentation of transcervical gunshot injuries.
• To assess the role of diagnostic investigations in managing these injuries.
• To determine the actual need for surgery in patients with transcervical gunshot wounds.

Main Methods:

• Prospective evaluation of 97 patients with neck gunshot injuries, focusing on 33 with transcervical injuries.
• Clinical assessment using a written protocol.
• Diagnostic workup included angiography, endoscopy, and esophagography as indicated.

Main Results:

• 73% of patients with transcervical gunshot wounds had injuries to cervical structures, including vascular (48%), spinal cord (24%), and aerodigestive tract (6%).
• Only 21% of patients with transcervical injuries underwent therapeutic operations.
• Nonoperative management resulted in no in-hospital deaths or local complications.

Conclusions:

• The study does not support mandatory surgery for all transcervical gunshot wounds.
• Clinical examination and appropriate diagnostic investigations should guide treatment decisions.
• Approximately 80% of patients with transcervical gunshot injuries can be safely managed nonoperatively.