Is exploration mandatory in penetrating zone II neck injuries?

BACKGROUND

A policy of mandatory neck exploration for zone II injuries deep to platysma was promoted in the 1950s and was associated with a reduction in mortality when compared with expectant or delayed exploration. Recently many trauma centres have been practising selective neck exploration using physical examination and imaging to stratify patients to different management strategies. In the Auckland region, patients with penetrating zone II injury deep to platysma have been managed with mandatory neck exploration. As penetrating injuries in the Auckland region are caused by a range of sharp objects, with gunshot wounds rare, outcomes of management of zone II neck injuries in this population warrant investigation. The aim of this study was to determine the rate of therapeutic neck exploration in patients with penetrating zone II neck injury in the Auckland region and to suggest optimum management strategies for such injuries.

METHODS

Retrospective audit of all patients presenting to Auckland and Middlemore Hospitals, Auckland, New Zealand, between 1995 and 2005 was carried out. Review of electronic clinical records and operation notes was also carried out.

RESULTS

An overall positive neck exploration rate of 25% was obtained (87% for patients with hard signs on physical examination). Physical examination had a sensitivity of 93% and a positive predictive value of 87% in this case series. Neck exploration was not associated with known complications or missed injuries.

CONCLUSION

In the Auckland setting, physical examination would appear to be a safe and reliable method for the stratification of patients for either operative or conservative management.