Penetrating injuries to the neck. Selective management.

The management of penetrating neck trauma remains a controversial subject. Two distinct approaches have been advocated: "mandatory" versus "selective" exploration of all neck wounds. Surgical intervention in our institution is based upon the latter, a selective principle of individualization of the patient and his injury. Obvious early exploration is indicated for patients with evidence of major vascular injury, visceral injury, or with progressive neurologic deficit. In the absence of such signs of injury, the authors used a diagnostic protocol which includes esophagram and arteriography. This retrospective reviews and assesses the results of this selectively conservative policy.