Penetrating injuries to the neck: a safe, selective approach to management.

The most appropriate management of patients with penetrating injuries to the neck remains a controversial issue. In order to determine the safety and efficacy of a selective approach to the management of such patients, a retrospective review of our experience with penetrating injuries to the neck at Northwestern Memorial Hospital over the past 5 years since the designation as a Level I trauma center was undertaken. A total of 30 patients fulfilled entry criteria. Twelve patients underwent immediate operative exploration based upon clinical indications present at admission. Seventeen patients underwent further diagnostic evaluation, including angiography in 17 and contrast esophagography in eight. Endoscopy was used infrequently. The mortality rate was 13.3 per cent, there were two negative cervical explorations, and there were no missed injuries. The results support the application of a selective approach to the operative management of penetrating injuries to the neck.