Ultra‐low Velocity Penetrating Neck Trauma: Explore/Extract?

Objective 1) Describe the injury pattern caused by ultra‐low velocity (ULV) foreign body penetration of the neck in the context of self‐mutilation, and 2) Propose a conservative management strategy for removal of such foreign bodies when the likelihood of serious injury is low. Method Case series of 8 incidents of self‐inflicted ULV penetrating neck trauma in a single patient who presented to a tertiary care hospital between December 2007 and December 2008. Postoperative morbidity was analyzed according to the presenting signs, symptoms, and radiologic findings and to the extent of surgical intervention. Results Ten foreign bodies were removed on 8 separate occasions. Concerning physical signs were present on one occasion (bleeding); symptoms on 3 (dyspnea or odynophagia); and radiologic findings on 6. Seven objects were retrieved by targeted dissection, with a mean operative time of 27.7 ± 8.4 min. Three objects were removed in the context of formal neck exploration, each with an operative time of 65 min. No significant injuries were found after foreign body removal. Minor transient incisional pain was the only morbidity observed, and this did not vary with preoperative injury assessment or extent of surgical intervention. Conclusion In our series of ULV penetrating neck trauma, concerning CT findings were more common than signs/symptoms of serious injury. Morbidity from ULV foreign body penetration and from its surgical treatment was low, whether formal exploration or targeted extraction was performed. Imaging tended to overestimate injury but helped with surgical planning.