A penetrating neck injury is defined as one that penetrates the platysma.
Anatomic zones of the neck:
(1) Zone I: below and about the clavicles and the cricoid cartilage
(2) Zone III: above the angle of the mandible to the base of the skull
(3) Zone II: between Zones I and III
Parameters:
(1) evaluation for penetration of the platysma muscle
(2) evaluation for hemodynamic stability
(3) localization of the wound
(4) identification of features requiring mandatory neck exploration
Rules:
(1) If the platysma has not been penetrated, then the wound is closed and the patient observed.
(2) If the patient has a penetrating wound and is hemodynamically unstable, then the patient has an immediate neck exploration.
(3) If the patient has a penetrating wound, is hemodynamically stable, and has one or more reasons for a mandatory neck exploration, then the patient has a mandatory neck exploration.
(3a) If the wound is in Zone I, III or is multiple, then arteriography and barium swallow are done prior to surgery.
(3b) If the wound is in Zone II, then the patient goes to surgery immediately.
(4) All other patients have arteriography and a barium swallow.
(4a) If a significant lesion is identified (vascular lesion, leakage of barium), then the patient undergoes neck exploration.
(4b) If the studies are negative, then the patient is observed.
(4c) If the studies are equivocal, then the patient has a rigid or flexible esophagoscopy, ultrasonography or other studies as indicated. If a lesion is seen then the patient has surgery. Else the patient is observed.
