Penetrating vascular injuries of the face and neck: clinical and angiographic correlation.

A retrospective review was made of 139 clinically stable patients who had sustained penetrating trauma to the face and neck. The study was done to learn more about the indications for angiography and the impact of angiography upon patient management. Some relationship between the physical examination and the angiographic findings was found. In the presence of any one of four physical signs or symptoms (absent pulse, bruit, hematoma, or alteration of neurologic status) there was a 30% incidence of vascular injury. However, it is unlikely that a clinically significant traumatic vascular lesion will be missed if angiography is not obtained when these clinical signs and symptoms are not present. In the group of 78 patients who presented with only a wound penetrating the platysma and no other findings or symptoms, just two had vascular injuries on angiograms; one of these lesions was minor and the other did not affect the patient's management. There was a substantially higher rate (50%) of vascular injury in patients with trauma cephalad to the angle of the mandible compared with 11% of patients who had neck trauma. Gunshot wounds were associated with vascular damage more frequently than were stab wounds.