Selective management of penetrating XXXX using "no zone" approach.

@entity1 @entity9285 @entity548 @entity9389 @entity764
INTRODUCTION: Selective management has been the standard management protocol in penetrating @entity9389 (PNIs) since this approach has significantly reduced unnecessary neck exploration. The purpose of this study is to evaluate outcomes of selective management in PNIs using the "no zone" approach, in which the management is guided mainly by clinical signs and symptoms, not the location of the neck wounds. MATERIALS AND METHODS: A retrospective study was performed in @entity1 treated for PNIs at King Chulalongkorn Memorial Hospital (KCMH) from January 2003 to December 2013. The @entity1 with hard signs of @entity9389 (i.e., active @entity548 , significant haematoma, massive @entity9285 , and air bubbling through the neck wound) underwent emergency neck exploration. The asymptomatic @entity1 and the @entity1 with soft signs (other symptoms) were considered to be candidates for selective management. Data collection included demographic data, emergency department parameters, details of @entity9389 , and outcomes in terms of mortality, negative exploration rate, and missed injury rate. RESULTS: Eighty-six PNI @entity1 were treated at KCMH from 2003 to 2013, 64 of which sustained stab wounds, 12 gunshot wounds, 4 shotgun wounds, and 6 other causes. Thirty-six @entity1 presenting with hard signs underwent immediate neck exploration and there were 2 negative explorations. Twenty-six @entity1 with soft signs underwent selective investigations (including computed tomographic angiography in 21 @entity1 ), 5 @entity1 required neck explorations due to positive results of the investigations with one negative exploration. All of the twenty-four asymptomatic @entity1 were managed with close observation, none required subsequent neck exploration. There was no missed injury found in the present study. Successful non-operative management was carried out in 45 @entity1 (52%). The overall negative exploration rate was 7% (3 in 41 @entity1 undergoing neck exploration). Two @entity1 with hard signs died from associated @entity764 (mortality rate 2%). CONCLUSION: Selective management of penetrating @entity9389 based on physical examination and selective use of investigations (no zone approach) is safe and simple with low negative exploration rate and no missed injury.
