110 Bullet Wounds to the Neck

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Selective management of 110 patients with bullet wounds to the neck resulted in 31 explored and 79 observed. There was an overall mortality rate of 2.7%, well within that reported in the literature, which ranges from 2 to 6%. At our institution, it is believed that a substantial number of patients can be selectively managed, depending on the signs and symptoms, the site and direction of the trajectory, and whether the interval of time between injury and entrance to the hospital is longer than 6 hours. Patients who are stable and lack physical signs of obvious major neck injury are evaluated by diagnostic radiologic and endoscopic techniques. If no significant injury is found, they are admitted for observation. The efficacy of this mode of management is strengthened by savings in the costs of hospitalization, risks of undergoing an additional operation, overall negative exploration rate in the mandatory exploration studies, and our own results of selective management. We do not recommend this form of management for all institutions. It has been found that in this well-staffed teaching hospital with an extensive trauma service, experienced personnel doing careful and repeated physical examinations, in addition to 24-hour availability of radiologic and endoscopic modalities, the policy of selective management of bullet wounds to the neck can be adhered to. Further studies need to be done into the various mechanisms of penetrating neck trauma, separating each mechanism into morbidity, mortality, and treatment.

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