Penetrating neck injuries in the UK are more commonly associated with low velocity objects such as knives and blades as opposed to gunshots. To explore the neck requires careful consideration of the need to do so in line with Burgess et al.’s guidelines published recently, which tend to favour more conservative management. A review of the management of 63 patients with penetrating neck injuries over the last six years is presented. It is interesting that fewer patients presented from June to September and this is associated with the end of the football season. More patients presented on Saturdays and Mondays.
Open neck exploration was done on 22/63 (35%) patients of which 17 (77%) had no significant injury. Only nine of these 22 patients justified exploration according to the Burgess et al. guidelines.
The article illustrates overtreatment of these patients and indicates various modalities now available to shift towards the more recent trend of conservative management. Suspected pharyngeal injuries should be assessed with endoscopy or water soluble contrast agent before proceeding to surgical intervention. CT angiography is suggested for suspected vascular injuries. Airway compromise should of course be managed appropriately as was done in two of these patients, one requiring a tracheostomy. The authors emphasise the need for an algorithm to be developed, involving all specialities which receive these patients, namely ENT surgery, general surgery, maxillofacial surgery and accident and emergency. This would be a desirable development.
