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Chandrananth ML, Lee JD, Read D, Shakerian R. ' No zone' approach in the management of penetrating neck injuries - an Australian Tertiary Trauma Centre experience. ANZ J Surg 2024; 94:591-596. [PMID: 38525869 DOI: 10.1111/ans.18939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/20/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Penetrating neck injuries (PNIs), defined as deep to the platysma, can result in significant morbidity and mortality. Management has evolved from a zone-based approach to a 'no zone' algorithm, resulting in reduced non-therapeutic neck exploration rates. The aim of this study was to examine PNIs and its management trends in an Australian tertiary trauma centre, to determine if a 'no zone' approach could be safely implemented in this population, as has been demonstrated internationally. METHODOLOGY This was a retrospective observational study at a level 1 adult Australian tertiary trauma centre using prospectively collated data from January 2008 to December 2018. Observed data included age, gender, mechanism of injury, computed tomography angiography (CT-A) use and operative intervention. Patients were examined based on zone of injury and presenting signs - 'hard', 'soft' or 'asymptomatic'. Major outcomes were CT-A usage, positive CT-A correlation with therapeutic neck explorations and negative neck exploration rates. RESULTS This study identified 238 PNI patients, with 204 selected for review. Most injuries occurred in zone 2 (71.6%), with soft signs accounting for 53.4% of cases. Over 10 years, CT-A utilization increased from 55% to 94.1%, with positive CT-As being more likely to yield therapeutic neck explorations. There was a general decreased trend in operative intervention but without a clear reduction in non-therapeutic neck explorations. CONCLUSION Our data suggests similarities with results from around the world, demonstrating that the 'no zone' approach should be considered when managing PNIs, but with clinician discretion in individual cases.
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Affiliation(s)
- Meera L Chandrananth
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jordan D Lee
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rose Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Chandrananth ML, Zhang A, Voutier CR, Skandarajah A, Thomson BNJ, Shakerian R, Read DJ. ' No zone' approach to the management of stable penetrating neck injuries: a systematic review. ANZ J Surg 2021; 91:1083-1090. [PMID: 33480177 DOI: 10.1111/ans.16600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aim: to review outcomes of the 'no zone' approach to penetrating neck injuries (PNIs) with the advent of high-fidelity computed tomography-angiography (CT-A) in order to determine the most appropriate management for stable PNIs. DESIGN Systematic review. POPULATION Retrospective and prospective cohort studies of patients who sustained penetrating neck trauma, as defined by an injury which penetrates the platysma, and whose initial management involved CT-A evaluation. METHODS An extensive literature search was performed in July 2019 using the following databases: Pubmed Central, EMBASE, Medline and Cochrane CENTRAL. Only studies published in English from the last 15 years were included. RESULTS Nine cohort studies met inclusion criteria. There has been an increase in CT-A focussed evaluation of PNIs in recent years. CT-A is a highly sensitive and specific imaging choice and reduces negative neck exploration rates. A new management algorithm for stable patients involving initial radiological assessment using CT-A, and subsequent selective surgical exploration, is safe and effective. CONCLUSION The results of this review provide level 2A evidence that the 'no zone' approach to PNIs, complemented by CT-A and thorough clinical assessment, is a safe management strategy which reduces negative neck exploration rates.
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Affiliation(s)
- Meera L Chandrananth
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew Zhang
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Catherine R Voutier
- Health Sciences Library, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin N J Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rezvaneh Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David J Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,The University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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