Physical Examination and Arteriography in Patients With Penetrating Zone II Neck Wounds
Peter Beitsch, MD;
John A. Weigelt, MD;
Emmett Flynn, MS;
Shiela Easley, RN
Arch Surg. 1994;129(6):577-581.
Abstract
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Objective
To review the management of patients with penetrating zone II neck wounds to discern the value of physical examination and proximity arteriography for predicting arterial injury.
Design
A retrospective chart review of 178 patients treated for penetrating wounds to the neck.
Setting
A level I trauma facility in Dallas, Tex.
Patients
All patients seen from 1987 to 1991 with platysma penetration in zone II of the neck.
Intervention
Physical examination, arteriography, and surgical exploration were used to identify patients with arterial injuries in the neck after penetrating trauma.
Main Outcome Measures
To identify the presence or absence of an arterial injury.
Results
Negative findings on physical examination ruled out an arterial injury in 99% of all patients. Patients with any sign of arterial injury had a 26% incidence of arterial injury confirmed at operation. Of 71 arteriograms in patients without signs or symptoms of arterial injury, only one had an arterial injury requiring operative intervention.
Conclusions
Findings on physical examination are good predictors of arterial injury in patients with penetrating neck wounds and can exclude injury in over 99% of patients. Arteriography is a sensitive test but has a very low yield (1.4%). These findings question whether the current practice of mandatory neck exploration or proximity arteriography is necessary for patients without signs or symptoms of injury who have penetrating wounds of the neck.
(Arch Surg. 1994;129:577-581)
Author Affiliations
From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas (Dr Beitsch, Mr Flynn, and Ms Easley), and the Department of Surgery, University of Minnesota and St Paul—Ramsey Medical Center, St Paul (Dr Weigelt).
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