Management of Penetrating Neck Injuries

Penetrating neck injuries pose a unique therapeutic challenge due to the density of vital vascular, respiratory and upper alimentary structures in a small anatomical region. Management has evolved from mandatory exploration of all wounds breaching the platysma muscle toward a more selective, clinically guided strategy. Initial assessment focuses on airway security, control of catastrophic haemorrhage and rapid identification of ‘hard signs’ such as expanding haematoma, active bleeding or airway compromise. Clinically stable patients without hard signs undergo cross-sectional imaging—most commonly multi-detector computed tomography angiography (MDCTA)—to delineate vascular and aerodigestive tract integrity. This permits avoidance of negative explorations and reduces morbidity. In unstable cases or where imaging is unavailable, prompt surgical exploration remains standard, with tailored incisions to optimise exposure. Recent advances stress a shift from rigid zonal protocols to algorithms integrating haemodynamic status, imaging findings and physical examination, thereby improving resource utilisation and patient outcomes. Pre-hospital care has also been refined, emphasising structured assessment (cABCD: catastrophic haemorrhage, Airway, Breathing, Circulation, Disability), tailored haemorrhage control techniques and rapid triage to definitive care.

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Management of Penetrating Neck Injuries publication trend

The graph below shows the total number of articles in management of penetrating neck injuries across all publications each year (not limited to Nature Index journals).

Technical terms

Platysma: A superficial neck muscle; penetration beyond this layer traditionally indicates need for further evaluation.

Zonal classification: Division of the neck into zones I–III based on anatomical landmarks to guide exploration decisions.

No-zone approach: A management strategy that prioritises clinical examination and imaging over strict adherence to anatomical zones.

Multi-detector computed tomography angiography (MDCTA): Advanced cross-sectional imaging modality providing rapid, high-resolution assessment of vascular and aerodigestive injuries.

References

1. Safety in selective surgical exploration in penetrating neck trauma. World Journal of Emergency Surgery (2016).
2. Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach. BJS Open (2020).
3. Pre-hospital management of penetrating neck injuries: a scoping review of current evidence and guidance. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2021).