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- Title
'No zone' approach to the management of stable penetrating neck injuries: a systematic review.
- Authors
Chandrananth, Meera L.; Zhang, Andrew; Voutier, Catherine R.; Skandarajah, Anita; Thomson, Benjamin N. J.; Shakerian, Rezvaneh; Read, David J.
- 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.
- Subjects
NECK injuries; PENETRATING wounds; COMPUTED tomography
- Publication
ANZ Journal of Surgery, 2021, Vol 91, Issue 6, p1083
- ISSN
1445-1433
- Publication type
Article
- DOI
10.1111/ans.16600