Concomitant injury beyond the neck is common. The incidence of carotid artery injury from a PNI ranges from 6 to 17 percent. Exsanguination is the most common cause of immediate death, and the carotid artery is the structure most often involved. Mortality rates for PNIs appear to be highest with zone I injuries (below the cricoid cartilage) due in part to the proximity of mediastinal structures, the severity of the vascular injuries sustained, and surgical challenges. PNI has been categorized by anatomic zones ( figure 1), which are described below. Mortality from PNI during the past decade is reported to be approximately 5 percent in both civilian and war populations. High velocity injuries carry a greater likelihood of serious injury and death. Wounds caused by low-velocity guns or impaling objects tend to cause fewer aerodigestive and vascular injuries. Penetrating thoracic trauma: (see "Initial evaluation and management of penetrating thoracic trauma in adults" and "Approach to the initially stable child with blunt or penetrating injury")ĮPIDEMIOLOGY - Penetrating neck injuries (PNIs) comprise 5 to 10 percent of traumatic injuries in adults and are caused primarily by bullets, knives, and other impaling objects (eg, shrapnel, glass).General pediatric trauma: (see "Trauma management: Approach to the unstable child" and "Approach to the initially stable child with blunt or penetrating injury" and "Trauma management: Overview of unique pediatric considerations").General adult trauma: (see "Initial management of trauma in adults" and "Approach to shock in the adult trauma patient"). General evaluation of the trauma patient and the management of other injuries are discussed separately. The initial evaluation and management of PNIs is reviewed here. PNI can cause life-threatening injuries to the aerodigestive and neurovascular systems. INTRODUCTION - Penetrating neck injuries (PNIs) refer to neck injuries resulting from gunshot wounds, stab wounds, or penetrating debris (eg, glass or shrapnel) that penetrate the platysma.
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