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Zone 2 Vascular Injury
Patients who are in profound shock or who are exsanguinating
from the neck wound should go directly to the operating
room for haemorrhage control. Patients who have an evolving
stroke should also undergo immediate exploration. There
is little to be gained from angiography with Zone 2
neck injuries. Surgical exploration and control is fairly
standard for most injuries to the vessels in this region.
The patient below had a stab injury to the left common
carotid artery, which was repaired with a vein patch.
 
Patients who are not exsanguinating and do not have
an evolving stroke. should have a careful physical examination.
If there is no expanding haematoma, no shock and no
evolving stroke, patients may be observed in a critical
care area. Although angiography will exclude a significant
vascular injury, physcial examination has been shown
to be as accurate in the assessment of Zone 2 injuries.
Soft signs such as proximity injuries, non-expanding
haematomas and a history of haemorrhage are not indications
for angiography or surgery.
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