'No zone' approach in the management of penetrating neck injuries - an Australian Tertiary Trauma Centre experience.
ANZ J Surg
; 94(4): 591-596, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-38525869
ABSTRACT
PURPOSE:
Penetrating neck injuries (PNIs), defined as deep to the platysma, can result in significant morbidity and mortality. Management has evolved from a zone-based approach to a 'no zone' algorithm, resulting in reduced non-therapeutic neck exploration rates. The aim of this study was to examine PNIs and its management trends in an Australian tertiary trauma centre, to determine if a 'no zone' approach could be safely implemented in this population, as has been demonstrated internationally.METHODOLOGY:
This was a retrospective observational study at a level 1 adult Australian tertiary trauma centre using prospectively collated data from January 2008 to December 2018. Observed data included age, gender, mechanism of injury, computed tomography angiography (CT-A) use and operative intervention. Patients were examined based on zone of injury and presenting signs - 'hard', 'soft' or 'asymptomatic'. Major outcomes were CT-A usage, positive CT-A correlation with therapeutic neck explorations and negative neck exploration rates.RESULTS:
This study identified 238 PNI patients, with 204 selected for review. Most injuries occurred in zone 2 (71.6%), with soft signs accounting for 53.4% of cases. Over 10 years, CT-A utilization increased from 55% to 94.1%, with positive CT-As being more likely to yield therapeutic neck explorations. There was a general decreased trend in operative intervention but without a clear reduction in non-therapeutic neck explorations.CONCLUSION:
Our data suggests similarities with results from around the world, demonstrating that the 'no zone' approach should be considered when managing PNIs, but with clinician discretion in individual cases.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Wounds, Penetrating
/
Neck Injuries
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Oceania
Language:
En
Journal:
ANZ J Surg
Year:
2024
Document type:
Article
Affiliation country:
Australia