Ann Surg Case Rep | Volume 2, Issue 3 | Case Report | Open Access

Zone 2 Neck Impalement: A Case Report and Review of Management

Marco Olivo*, Stefano Spanio di Spilimbergo, Massimo Brunello and Ugo Baciliero

Department of Maxillofacial, Regional Hospital of Vicenza, Vicenza, Italy

*Correspondance to: Marco Olivo 

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Penetrating Neck Injury (PNI) could cause significant mortality because of many vital structures packed in a relatively small area. Management of PNI is challenging and selective management has been considered the standard care with minimal risk to patient safety. Hereby the authors present a case of a 16-year-old male patient that was brought to the emergency department by ambulance following a motor accident with a penetrating, to-through-to left to the right side, wound of the neck caused by a large wooden part of a fence. We review the management of these types of injuries. As soon as a patient with penetrating neck injury comes to the emergency room rapid assessment with the primary survey is essential. The goal of the primary survey by the Advanced Trauma Life Support (ATLS) protocol advocated by the American College of Surgeons is to establish a secure airway, assure breathing/respiration and initiate volume reuscitation. Once the patient is stabilized a second survey is carried out checking for symptoms and signs of subcutaneous emphysema, hoarseness, stridor, and respiratory distress and external injuries to the neck as hematoma, external bleeding, and air bubbling from a wound. Surgical exploration was the principal form of treatment during past few decades but reports documenting the management of PNI have shown high rates of non therapeutic exploratory cervicotomies. Major signs and symptoms of vascular or aero digestive injuries should prompt emergent surgical exploration. The selective management based in physical examination and diagnostic studies is safe and feasible in stable patients decreasing the incidence of non therapeutic cervicotomies with low rates of morbidity. However foreign bodies must be removed in the operatory room with caution


Neck injury; Foreign bodies; Accidents; Trauma; Wounds


Olivo M, di Spilimbergo SS, Brunello M, Baciliero U. Zone 2 Neck Impalement: A Case Report and Review of Management. Ann Surg Case Rep. 2019; 2(3): 1020.

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