Penetrating wounds of the neck in civilians.

The management of penetrating neck wounds can be approached in a logical manner. The priorities in saving life are to ensure an airway and to maintain cardiocerebral perfusion. The initial evaluation and heroic life saving measure often rest upon the most inexperienced person, the house officer, who may be handicapped by the lack of experienced support personnel and sophisticated diagnostic and therapeutic equipment required for total management of these most challenging problems. It is hoped that this presentation provides the necessary guidelines for meeting this challenge. The pathophysiology, diagnostic approaches, and therapeutic measures are reviewed in the order in which they would be handled when the patient is brought to the emergency room, taken for special radiographic studies, and then subjected to surgical exploration. Special emphasis is placed upon diagnosis and management of traumatic arterial injuries, since these are the most challenging and most difficult to manage, as well as the most common causes of death following cervical penetrating wounds. Late vascular defects and associated injuries to the lymphatic, neural, airway, and foodway systems complete the discussion.