A 32-year-old man is found to have a Zone II penetrating neck injury (between the angle of the mandible and the cricoid cartilage) following a stab wound. He is haemodynamically stable with no airway compromise. What is the current recommended management approach?
- A Selective management: CT angiography and clinical observation if stable, with surgery only if an injury is identified ✓
- B Mandatory surgical exploration of all Zone II penetrating neck injuries
- C Immediate angiography and endovascular stenting
- D Observation only without imaging for 24 hours
Explanation
The historical 'No-Zone' or 'selective management' approach has replaced mandatory exploration for Zone II neck injuries in haemodynamically stable patients without hard signs (active haemorrhage, expanding haematoma, airway compromise, neurological deficit). CT angiography (CTA) is now the investigation of choice; it identifies vascular and aerodigestive injuries with high sensitivity, allowing targeted surgical or endovascular intervention only when injury is confirmed. Mandatory exploration (the old approach) had high negative exploration rates (~50%). Haemodynamically unstable or patients with hard signs go directly to the operating room.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.