title: Management of penetrating neck injuries.
abstract: BACKGROUND
  Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI.
  
  
  METHODS
  Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations.
  
  
  RESULTS
  Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected.
  
  
  CONCLUSIONS
  FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.
authors.affiliation: Departments of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: O J
authors.initials: OJ
authors.lastname: Van Waes
authors.forename: K C A L
authors.initials: KC
authors.lastname: Cheriex
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: P A
authors.initials: PA
authors.lastname: van Riet
authors.forename: A J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: J
authors.initials: J
authors.lastname: Vermeulen
mesh_terms: D000293:Adolescent; D000328:Adult; D021721:Balloon Occlusion / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000628:therapy*; D012137:Respiratory System / Q000293:injuries; D057772:Vascular System Injuries / Q000628:therapy; D014950:Wounds, Penetrating / Q000628:therapy*; D055815:Young Adult