open wounds to neck

Introduction

open wounds such as knife wounds to the neck which penetrate platysma are potentially life threatening with potential for vascular, trachea, oesophageal, nerve injury as well as pneumothorax, etc.
wounds are usually assessed according to zones
- zone 1
  - the area between the clavicles and the cricoid cartilage
  - highest risk of lethal injuries, particularly vascular and delayed Dx of oesophageal injuries
  - usually requires CXR to exclude pneumothorax as well as consideration for CT angio
  - oesophagoscopy should be considered if oesophageal injury is suspected
- zone 2
  - the area between the cricoid cartilage and the angle of the mandible
  - most common zone for penetrating injuries
  - consideration for CT angio
- zone 3
  - the area between the angle of the mandible and the base of the skull
  - less amenable to physical examination and difficult to explore during surgical evaluation
  - consideration for CT angio

usual trauma Mx protocols including ABCDE, dressings to reduce bleeding, IV access, Xmatch if indicated
- NB. if cervical spine injury is possible then usual Cx spine precautions should be used
Hx and exam to assess wound(s)
if wound is thought to be deeper than platysma then consider:
- CXR - esp. if Zone 1
- CT angio
- oesophagoscopy if oesophageal injury is suspected - especially if Zone 1
- referral for surgical mx - surgical exploration is easiest for zone 2 injuries
tetanus prophylaxis as usual