The evolving management of penetrating neck injuries.

The management of penetrating neck injuries has changed tremendously in the last 20 years. During the 1960s and 1970s the golden rule for such injuries was mandatory neck exploration. This policy became generally accepted because of the anatomical proximity of the neck to important structures, the potential of disastrous consequences, and previous military experience. However, experience in the civilian setting of large trauma centers, together with economic considerations regarding unnecessary surgery prompted critical retrospective studies in the midseventies and early eighties. These studies revealed the staggering rate of up to 70% of non-therapeutic neck operations for penetrating injuries. As a result trauma surgeons set out to define a more selective and conservative approach, leading to the development of investigational management algorithms to treat these injuries. In this review we present our assessment of the literature on the evolving management and treatment of penetrating neck injuries, and an evaluation of the results of recent prospective studies and treatment algorithms.