Klyachkin et al identified a number of criteria for mandatory neck exploration following a penetrating injury to the neck. A patient who does not have any of these criteria may be able to avoid unnecessary surgery. The authors are from the University of Kentucky in Lexington.


A penetrating neck injury is defined as one that penetrates the platysma.


Criteria for mandatory neck exploration:

(1) hemorrhagic shock

(2) continued arterial and/or venous hemorrhage (active bleeding from wound)

(3) massive or expanding hematoma

(4) vascular bruit over neck

(5) neurologic deficit secondary to arterial injury

(6) tracheal exposure

(7) wound blowing or sucking air

(8) dysphonia or hoarseness

(9) dysphagia

(10) hemoptysis

(11) subcutaneous emphysema


Management is affected by the zone affected (Zone I, II, III) and the number of penetrating injuries.


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