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Introduction <p>The traditional approach to the assessment and management, of penetrating neck injury relies heavily on the anatomical zones of the neck. This is particularly germane to identifying patients who need imaging. The rise of modern CT angiography as a safe, reliable and ubiquitous imaging modality, has called this into question.</p> Materials and methods <p>A retrospective study was conducted at a major trauma centre in South Africa over a twelve-year period on all patients with gunshot wounds (GSWs) to the neck. The correlation between external wound and the actual internal injuries were examined.</p> Results <p>Two hundred and thirty-nine (239) patients were included (91% male, mean age: 32 years, SD 12). The most encountered external wound was Zone II with 76 (32%) patients, followed by Zone I with 46 (20%) and Zone III with 37 (15%). The 239 patients sustained a total of 119 internal injuries. Of these 119 internal injuries, 45% (53) did not correlate with the level of the external wound. The internal injuries identified were, vascular in 39 cases of which there were 28 exclusive arterial injuries: 28 exclusive venous injures and four combined arterial and venous injuries. There were seven aerodigestive tract injuries and 44 and nerve injuries. The overall mortality rate was 7% (16).</p> Conclusions <p>The level of the external neck wound following a GSW of the neck, correlates poorly with any internal injury. This calls into question the clinical utility of the traditional zonal approach in streamlining the management of these patients.</p>

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Limited clinical utility in the anatomical zones of the neck in selecting patients with gunshot wounds to the neck for imaging

  • 期刊论文

  • 发表日期：

    2025年11月25日

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  • William Yeung,
  • Victor Kong,
  • Daniel Lee,
  • Jonathan Ko,
  • Reuben He,
  • Joshua Ahn,
  • Hong Lee,
  • Howard Wain,
  • Wanda Bekker,
  • Damian Clarke

摘要

Introduction

The traditional approach to the assessment and management, of penetrating neck injury relies heavily on the anatomical zones of the neck. This is particularly germane to identifying patients who need imaging. The rise of modern CT angiography as a safe, reliable and ubiquitous imaging modality, has called this into question.

Materials and methods

A retrospective study was conducted at a major trauma centre in South Africa over a twelve-year period on all patients with gunshot wounds (GSWs) to the neck. The correlation between external wound and the actual internal injuries were examined.

Results

Two hundred and thirty-nine (239) patients were included (91% male, mean age: 32 years, SD 12). The most encountered external wound was Zone II with 76 (32%) patients, followed by Zone I with 46 (20%) and Zone III with 37 (15%). The 239 patients sustained a total of 119 internal injuries. Of these 119 internal injuries, 45% (53) did not correlate with the level of the external wound. The internal injuries identified were, vascular in 39 cases of which there were 28 exclusive arterial injuries: 28 exclusive venous injures and four combined arterial and venous injuries. There were seven aerodigestive tract injuries and 44 and nerve injuries. The overall mortality rate was 7% (16).

Conclusions

The level of the external neck wound following a GSW of the neck, correlates poorly with any internal injury. This calls into question the clinical utility of the traditional zonal approach in streamlining the management of these patients.