Physical examination and arteriography in patients with penetrating zone II neck wounds

Abstract

Objective: To review the management of patients with penetrating zone II neck wounds to discern the value of physical examination and proximity arteriography for predicting arterial injury.

Design: A retrospective chart review of 178 patients treated for penetrating wounds to the neck.

Setting: A level I trauma facility in Dallas, Tex.

Patients: All patients seen from 1987 to 1991 with platysma penetration in zone II of the neck.

Intervention: Physical examination, arteriography, and surgical exploration were used to identify patients with arterial injuries in the neck after penetrating trauma.

Main outcome measures: To identify the presence or absence of an arterial injury.

Results: Negative findings on physical examination ruled out an arterial injury in 99% of all patients. Patients with any sign of arterial injury had a 26% incidence of arterial injury confirmed at operation. Of 71 arteriograms in patients without signs or symptoms of arterial injury, only one had an arterial injury requiring operative intervention.

Conclusions: Findings on physical examination are good predictors of arterial injury in patients with penetrating neck wounds and can exclude injury in over 99% of patients. Arteriography is a sensitive test but has a very low yield (1.4%). These findings question whether the current practice of mandatory neck exploration or proximity arteriography is necessary for patients without signs or symptoms of injury who have penetrating wounds of the neck.