Proximity matters: Assessing vascular injury and surgical decision-making in penetrating neck trauma

Background: Penetrating neck trauma poses significant risks due to critical anatomical structures. This study evaluates the impact of explosion fragment proximity to major vessels on the need for surgical exploration and outcomes, during a high-intensity urban warfare conflict. Methods: We conducted a retrospective review of medical records from penetrating neck trauma patients at a tertiary hospital from October 2023 to April 2024. Analyses included demographics, injury specifics, radiology, surgical interventions, and outcomes. Results: The cohort comprised 24 male soldiers, 10 of whom had vascular injuries. Those with suspected vascular injuries had notably higher rates of neck exploration (90 % vs. 21 %), ICU admissions (70 % vs. 29 %), and ICU stay duration [median 2.50 (IQR 0–55) days vs. 0 (IQR 0–10) days]. Complication rates were also higher in this group (80 % vs. 7 %), including, but not limited to, post-operative hoarseness (40 % vs. 0 %). A distance shorter than 5 mm from a fragment to a major blood vessel was correlated with the decision to undergo neck exploration (85 % vs. 9 %), ICU hospitalization (69 % vs. 18 %), to suffer from vascular injury 77 % vs. 9 %) or complications (77 % vs. 0 %). Conclusions: Advanced imaging is crucial in managing penetrating neck trauma, with a <5 mm proximity threshold from a fragment to a major blood vessel influencing surgical and ICU decisions. Vascular injuries are associated with worse outcomes, emphasizing the need for precise diagnostics and multidisciplinary approach including head and neck surgeons, radiologists, interventional radiologists, orthopedics, ICU and Anesthesia. Future research should focus on prospective studies to refine clinical guidelines and enhance outcomes.