Defining Zone I of Penetrating Neck Trauma. A Surgical controversy in the light of Clinical Anatomy.

Defining Zone I of Penetrating Neck Trauma. A Surgical controversy in the light of Clinical Anatomy.

J Trauma Acute Care Surg. 2016 Jan 21;

Authors: Rodríguez-Luna MR, Guarneros-Zárate JE, Hérnandez-Méndez JR, Tueme-Izaguirre J, Noriega-Usi V, Fenig-Rodríguez J

Abstract
In 1969, Monson proposed a classification for triage purposes in penetrating neck trauma based in zones in a paper addressing carotid and vertebral injuries. Zone I below the jugular notch, even though it is not located in the neck itself, but in the superior mediastinum; Zone II from the latter point to the mandible angle and Zone III above mandible angle to the base of the skull. Ten years later, Roon published an alternate classification, considering a Low Zone extending from the clavicles to the cricoid cartilage, a more anatomical correct classification considering that its location at the base of the neck. Current publications take one of the two classifications either, despite making the mistake of defining the anatomical superior mediastinum and axilla as part of the neck region. Many authors have considered this differences as not clinically relevant, but the two classifications are still in use in the clinical research and decision-making process for treatment of penetrating neck injuries. What is a fact is that this anatomical region is complex on itself and surgical management of penetrating injuries to the vital elements crossing the superior thoracic aperture often requires a high anterior thoracotomy, median sternotomy or supraclavicular incision with claviculectomy in the search of vascular control for the carotid, vertebral, subclavian and axillary vessels. In the present paper, we consider to be appropriate to define the Zone I bellow the cricoid cartilage extending to the sternal angle encompassing a "thoracocervicoaxiallary" zone. The acute-care surgeon must master this region for the treatment of penetrating injuries located in such a complex anatomical region. We present a historical review of the evolution in the surgical care of these wounds. Until now, we have no standardized classification leading to confusion among surgical students, and acute-care surgeons making it impossible for future systematic reviews and meta-analysis.

PMID: 26808025 [PubMed - as supplied by publisher]

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