Skip to main content
SpringerLink
Log in

Current Management of Penetrating Traumatic Cervical Vascular Injuries

  • Trauma Surgery (J Diaz, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Penetrating neck injuries constitute 5–10% of all emergency trauma presentations and are associated with a relatively high risk of mortality. The most common significant injury encountered in penetrating neck trauma is injury to the vasculature of the neck. This article reviews penetrating cervical vascular injuries, including initial assessment, immediate, and definitive management techniques.

Recent Findings

Assessment and management of penetrating injuries to the neck have traditionally been approached according to the location of the injury in relation to anatomic zones of the neck. More recently, due to advancements in imaging techniques and endovascular therapies, there is a trend towards non-operative management. This has resulted in a decrease in the rate of non-therapeutic surgeries.

Summary

Penetrating traumatic cervical vascular injuries are potentially life-threatening and require appropriate clinical assessment to rapidly identify patients who need immediate surgical intervention. However, patients without hard signs of vascular injury should undergo imaging, most commonly in the form of computed tomographic angiography. For patients who require operative intervention, surgical techniques include vessel ligation, direct repair or angioplasty, interposition grafts, and damage control procedures. Endovascular techniques are particularly useful in the management of vascular injuries of the vertebral artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Publications of particular interested have been highlighted as: • Of importance, •• Of major importance

  1. Nason RW, Assuras GN, Gray PR. Lipschitz J (2001) Penetrating neck injuries: analysis of experience from a Canadian trauma centre. Can J Surg. 2001;44(2):122–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. ••Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R, et al. Western trauma association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg. 2013;75:936–40.

    Article  Google Scholar 

  3. McConnell DB, Trunkey DD. Management of penetrating trauma to the neck. Adv Surg. 1994;1994(27):97–127.

    Google Scholar 

  4. Saito N, Hito R, Burke PA, Sakai O. Imaging of penetrating injuries of the head and neck: current practice at a level 1 trauma centre in the United States. Keio J Med. 2014;63:23–33.

    Article  Google Scholar 

  5. Steenburg SD, Sliker CW, Shanmuganathan K, Siegel EL. Imaging evaluation of penetrating neck injuries. Radiographics. 2013;30:869–86.

    Article  Google Scholar 

  6. Borsetto D, Fussey J, Mavuti J, Colley S, Pracey P. Penetrating neck trauma: radiological predictors of vascular injury. Eur Arch Otorhinolaryngol. 2019;2019(276):2541–7.

    Article  Google Scholar 

  7. Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: a guide to evaluation and management. Ann R Coll Surg Engl. 2018;2018(100):6–11.

    Article  Google Scholar 

  8. •Teixeira F, Menegozzo AM, Netto SDC, Pogeti RS, Silva FSC, Birolini D, Bernini CO, Utiyama EM. Safety in selective surgical exploration in penetrating neck trauma. World J Emerg Surg. 2016;11:32. https://doi.org/10.1186/s13017-016-0091-4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Powers DB, Delo RI. Characteristics of ballistic and blast injuries. Atlas Oral Maxillofac Surg Clin North Am. 2013;21(1):15–24.

    Article  Google Scholar 

  10. Rezende-Neto JB, Ferreira GC, Silva Filho AL, Fontes MOB, Bomfim F, Abrantes WL. Kiting injuries: report of two cases and review of the literature. J Trauma. 2000;48:310–1.

    Article  Google Scholar 

  11. Bell BR, Osborn T, Dierks EJ, Potter BE, Long WB. Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral Maxillofac Surg. 2007;65(4):691–705.

    Article  Google Scholar 

  12. Demetriades D, Asensio JA, Velmahos G, Thal. E. Complex problems in penetrating trauma. Surg Clin North Am. 1996;1996(76):661–83.

    Article  Google Scholar 

  13. Fogelman MJ, Stewart RD. Penetrating wounds of the neck. Am J Surg. 1956;91:581–93.

    Article  CAS  Google Scholar 

  14. Monson DO, Saletta JD, Freeark RJ. Carotid vertebral trauma. J Trauma. 1969;1969(9):987–99.

    Article  Google Scholar 

  15. Roon AJ, Christensen N. Evaluation and treatment of penetrating cervical injuries. J Trauma. 1979;1979(19):391–7.

    Article  Google Scholar 

  16. Apffelstaedt JP, Muller R. Results of mandatory exploration for penetrating neck trauma. World J Surg. 1994;1994(18):917–9.

    Article  Google Scholar 

  17. Ayuyao AM, Kaledzi YL, Parsa MH, Freeman HP. Penetrating neck wounds Mandatory versus selective exploration. Ann Surg. 1985;202(5):563–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. ••Ibraheem K, Khan M, Rhee P, Azim A, O’Keeffe T, Tang A, et al. “No zone” approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations. J Surg Res. 2018;2018(221):113–20.

    Article  Google Scholar 

  19. ••Inaba K, Branco BC, Menaker J, Scalea TM, Crane S, DuBose JJ. Evaluation of multidetector computed tomography for penetrating neck injury: a prospective multicentre study. J Trauma. 2012;72(3):576–84.

    Article  Google Scholar 

  20. Low GMI, Inaba K, Chouliaras K, Branco B, Lam L, Benjamin E, et al. The use of the anatomic ‘Zones’ of the neck in the assessment of penetrating neck injury. Am Surg. 2014;2014(80):970–4.

    Google Scholar 

  21. Prichayudh S, Choadrachata-anun J, Sriussadaporn S, Pak-art R, Srriussadaporn P, Kritayakirana K, et al. Selective management of penetrating neck injuries using “no zone” approach. Injury. 2015;46:1720–5.

    Article  Google Scholar 

  22. Shiroff AM, Gale SC, Martin ND, Marchalik D, Petrov D, Ahmed HM. Penetrating neck trauma: A review of management strategies and discussion of the ‘No Zone’ approach. Am Surg. 2013;2013(79):23–9.

    Google Scholar 

  23. •Golueke PJ, Goldstein AS, Sclafani SJA, Mitchell WG, Shaftan GW. Routine versus selective exploration of penetrating neck injuries: a randomised prospective study. J Trauma. 1984;24(12):1010–4.

    Article  CAS  Google Scholar 

  24. Demetriades D, Charalambides D, Lakhoo M. Physical examination and selective conservative management in patients with penetrating injuries of the neck. Br J Surg. 1993;80:1534–6.

    Article  CAS  Google Scholar 

  25. Demetriades D, Theodorou D, Cornwell E, et al. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg. 1997;21:41–7.

    Article  CAS  Google Scholar 

  26. Osborn TM, Bell RB, Qaisi W, et al. Computed tomographic angiography as an aid to clinical decision making in the selective management of penetrating injuries to the neck: a reduction in the need for operative exploration. J Trauma. 2008;64:1466–71.

    Article  Google Scholar 

  27. Thoma M, Navsaria PH, Edu S, et al. Analysis of 203 patients with penetrating neck injuries. World J Surg. 2008;32:2716–23.

    Article  Google Scholar 

  28. American College of Surgeons Committee on Trauma. Advanced trauma life support for doctors. 8th ed. Chicago: American College of Surgeons; 2012. p. 2012.

    Google Scholar 

  29. Burgess CA, Dale OT, Almeyda R, Corbridge RI. An evidence based review of the assessment and management of penetrating neck trauma. Clin Otolaryngol. 2012;2012(37):44–52.

    Article  Google Scholar 

  30. Connell RA, Graham CA, Munro PT. Is spinal immobilisation necessary for all patients sustaining isolated penetrating trauma? Injury. 2003;2003(34):912–4.

    Article  Google Scholar 

  31. •Rhee P, Kuncir EJ, Johnson L. Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault. J Trauma. 2006;2006(61):1166–70.

    Article  Google Scholar 

  32. •Vanderlan WB, Tew BE, McSwain NE. Increased risk of death with cervical spine immobilisation in penetrating cervical trauma. Injury. 2009;2009(40):880–3.

    Article  Google Scholar 

  33. Schroll R, Fontenot T, Lipcsey M, Heaney JB, Marr A, Meade P, et al. Role of computed tomography angiography in the management of zone II penetrating neck trauma in patients with clinical hard signs. J Trauma Acute Care Surg. 2015;79(6):943–50.

    Article  Google Scholar 

  34. Rezende-Neto J, Marques AC, Guedes LJ, Teixeira LC. Damage control principles applied to penetrating neck and mandibular injury. J Trauma. 2008;64(4):1142–3.

    Article  Google Scholar 

  35. ••Strickland M, Roedel E, Inaba K. Penetrating cervical vascular injuries. Curr Trauma Rep. 2019;2019(5):40–7.

    Article  Google Scholar 

  36. Warriner Z, Lam L, Matsushima K, Benjamin E, Strumwasser A, Demetriades D, et al. Initial evaluation of the efficacy and safety of in-hospital expandable haemostatic minisponge use in penetrating trauma. J Trauma Acute Care Surg. 2019;86(3):424–30.

    Article  Google Scholar 

  37. Rodríguez-Luna MR, Guarneros-Zárate JE, Hernández-Méndez JR, Tueme-Izaguirre J, Noriega-Usi VM, Fenig-Rodriguez J. Defining Zone I of penetrating neck trauma: a surgical controversy in the light of clinical anatomy. J Trauma Acute Care Surg. 2016;80:670–3.

    Article  Google Scholar 

  38. Demetriades D, Skalkides J, Sofianos C, Melissas J, Franklin J. (1989) Carotid artery injuries: experience with 124 cases. J Trauma. 1989;29(1):91–4.

    Article  CAS  Google Scholar 

  39. Kesser BW, Chance E, Kleiner D, Young JS. Contemporary management of penetrating neck trauma. Am Surg. 2009;2009(75):1–10.

    Google Scholar 

  40. Biffl WL. Neck exploration. In: Cioffi, WG. (Ed). Atlas of trauma/emergency surgical techniques. Elsevier/Saunders 2014; pp 10–22.

  41. Inaba K, Aksoy H, Seamon MJ, Marks JA, Duchesne J, Schroll R, et al. Multicentre evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg. 2016;80(30):359–65.

    Article  Google Scholar 

  42. Herrara DA, Vargas SA, Dublin AB. Endovascular treatment of penetrating traumatic injuries of the extracranial carotid artery. J Vasc Interv Radiol. 2011;22(1):28–33.

    Article  Google Scholar 

  43. Rezende-Neto JB, Marcuzzi D, Paskar D, Sadler E, Marshall S, Nixon K, Inglez J, Marshall J. Multidisciplinary damage control management of life threatening carotid blowout syndrome. Trauma Surg Acute Care Open. 2018;3:1–2.

    Article  Google Scholar 

  44. Mwipatayi B, Jeffery P, Beningfield S, Motale P, Tunnicliffe J, Navasia P. Management of extra-cranial vertebral artery injuries. Eur J Vasc Endovasc Surg. 2004;27(2):157–62.

    Article  CAS  Google Scholar 

Download references

Funding

The authors declare no funding for this article

Author information

Authors and Affiliations

  1. Clinical Fellow in Trauma and Acute Care Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Lillian N. Jenkins

  2. Trauma and Acute Care Surgeon, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Joao B. Rezende-Neto

Authors
  1. Lillian N. Jenkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joao B. Rezende-Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joao B. Rezende-Neto.

Ethics declarations

Conflict of interest

The authors declare no conflict of interests with respect to the authorship or publication of this manuscript.

Human and Animal Rights and Informed Consent

All articles published by the authors included in this study involving human or animal subjects were approved by research ethics board of the institution and had patient consent for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Trauma Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jenkins, L.N., Rezende-Neto, J.B. Current Management of Penetrating Traumatic Cervical Vascular Injuries. Curr Surg Rep 8, 15 (2020). https://doi.org/10.1007/s40137-020-00258-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40137-020-00258-2

Keywords

Search

Navigation