Penetrating Cervical @entity130 : "Current Concepts in Penetrating XXXX ", IATSIC Symposium, International Surgical Society, Helsinki, Finland, August 25-29, 2013.

@entity1 @entity825 @entity7502 @entity1317 @entity1914 @entity130
UNASSIGNED: @entity1 with penetrating wounds to the neck present with overt symptoms and/or signs or are asymptomatic or modestly/moderately symptomatic. With overt symptoms and/or signs, immediate resuscitation and an emergency operation are appropriate. Asymptomatic @entity1 or those with modest or moderate symptoms and/or signs undergo observation or a diagnostic evaluation to avoid the 45  % "negative" exploration rate documented in the past (denominator  =  all @entity1 ). Asymptomatic @entity1 with penetration of the platysma muscle, but no signs of a @entity1317 , should undergo serial physical examinations every 6-8 for 24-36  h before discharge. Noncontrast CT does not add to the accuracy of serial physical examinations. In stable @entity1 with a variety of modest/moderate symptoms or signs possibly related to an @entity1914 , CT-arteriography has become the diagnostic modality of choice. @entity1 with possible @entity130 to the cervical esophagus are often still evaluated with a Gastrografin swallow and, if needed, a "thin" barium swallow prior to fiberoptic esophagoscopy. CT-esophagograms are likely to replace these time-honored studies in the near future. Over 85  % of @entity1 with @entity130 to the @entity825 present with overt symptoms or signs, while the remainder have historically been evaluated with laryngoscopy and fiberoptic bronchoscopy. Again, cervical multislice CT is likely to replace these studies. Operative repair of the carotid artery with 6-0 @entity7502 sutures requires heparinization and shunting on rare occasions. Both the @entity825 and esophagus are repaired with 3-0 absorbable sutures, and tracheostomy and esophageal diversion are used in only large and/or complex @entity130 . Sternal head or sternocleiodomastoid interposition flaps are used when combined visceral and @entity1317 are present.
