title: The nonoperative management of penetrating internal jugular vein injury.
abstract: OBJECTIVE
  The objective of this study was to review the outcome of nonoperative treatment for penetrating internal jugular vein (IJ) injuries in a continuous series of prospectively identified, hemodynamically stable patients.
  
  
  METHODS
  All penetrating neck injuries assessed from February 1, 2004, to August 31, 2004, were prospectively identified. Patients without an indication for urgent neck exploration underwent diagnostic assessment with multislice helical computed tomographic angiography with or without vascular ultrasonography. All IJ injuries with no other indication for surgical exploration were treated nonoperatively. All patients were discharged home and followed up for a minimum of 1 week to document outcomes.
  
  
  RESULTS
  From 51 neck injuries penetrating the platysma, 7 required urgent neck exploration, during which 2 IJ injuries were ligated. Forty-four patients underwent multislice helical computed tomographic angiography. Eight IJ injuries (two gunshot wounds and six stab wounds) with no other indication for neck exploration were identified and managed nonoperatively. One external wound was in zone 1, five were in zone 2, one was in zone 3, and one traversed all three zones. The average length of stay was 4.5 days. At follow-up, ranging from 1 week to 5 months, all patients were asymptomatic, and no patient required delayed operation for IJ injury.
  
  
  CONCLUSIONS
  In hemodynamically stable patients with no other indication for exploration, the nonoperative management of penetrating jugular vein injuries should be considered as a safe alternative.
authors.affiliation: Department of Surgery, Ryder Trauma Center, Miami, FL, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Felipe
authors.initials: F
authors.lastname: Munera
authors.forename: Mark G
authors.initials: MG
authors.lastname: McKenney
authors.forename: Luis
authors.initials: L
authors.lastname: Rivas
authors.forename: Edgardo
authors.initials: E
authors.lastname: Marecos
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Louis
authors.initials: L
authors.lastname: Pizano
authors.forename: Stephen
authors.initials: S
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D014950:Wounds, Penetrating / Q000628:therapy*