This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Management of penetrating neck injuries. BJS 2012; 99: 149-154.
Published: 22nd December 2011
Authors: O. J. Van Waes, K. C. A. L. Cheriex, P. H. Navsaria, P. A. van Riet, A. J. Nicol, J. Vermeulen et al.
Background
Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non‐operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI.
Method
Seventy‐seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations.
Results
Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow‐up no missed injuries were detected.
Conclusion
FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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