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ANZ journal of surgery
06, 2021;91 (6): 1083-1090.

'No zone' approach to the management of stable penetrating neck injuries: a systematic review.

Meera L Chandrananth, Andrew Zhang, Catherine R Voutier, Anita Skandarajah, Benjamin N J Thomson, Rezvaneh Shakerian, David J Read
Author Information
  1. Meera L Chandrananth: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. ORCID
  2. Andrew Zhang: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  3. Catherine R Voutier: Health Sciences Library, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  4. Anita Skandarajah: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  5. Benjamin N J Thomson: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  6. Rezvaneh Shakerian: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  7. David J Read: Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. ORCID
PMID: 33480177 DOI: 10.1111/ans.16600

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.

Keywords

computed tomography angiography no zone penetrating neck injury

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MeSH Term

Angiography
Humans
Neck Injuries
Prospective Studies
Retrospective Studies
Wounds, Penetrating
Journal Article Review Systematic Review

Word Cloud

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