w latach 19962012 leczeniu poddano 10 pacjentw z penetrujcymi urazami szyi , w tym 3 kobiety i 7 mczyzn . w 8 przypadkach bya to pojedyncza rana kuta , a w przypadku jednego pacjenta  34 rany kute szyi , klatki piersiowej i brzucha . wszystkich pacjentw poddano natychmiastowemu zabiegowi polegajcemu na rewizji ran szyi ( 8 przypadkw ) , sternotomii z podunym przeciciem mostka ( 1 przypadek ) oraz lewostronnej torakotomii ( 1 przypadek ) . wskazania do zabiegu obejmoway rozedm podskrn ( 5 pacjentw ) , krwawienie z rany ( 3 pacjentw ) i hematom rdpiersia ( 2 pacjentw ) . wrd urazw stwierdzonych rdoperacyjnie byy uszkodzenia tchawicy ( 6 pacjentw ) , ttnic szyjnych ( 3 pacjentw ) , krtani ( 2 pacjentw ) , naczy klatki piersiowej ( 2 pacjentw ) , przeyku ( 1 pacjent ) i gruczou tarczowego ( 1 pacjent ) . w przypadku 9 pacjentw leczenie przynioso pozytywne efekty . wczesna i szybka diagnostyka u pacjentw z penetrujcymi ranami szyi pozwala okreli wskazania do zabiegu i zapobiec miertelnym powikaniom . the first descriptions of the treatment of penetrating neck wounds come from 1522 , when ambroise par described the technique of tying large vessels at the site of injury . those principles were later used during world war i. mortality from neck wounds was evaluated at 60% at that time . during world war the mortality rate dropped to 6% in early wound reviewing , in comparison to 35% in cases of delays in treatment [ 1 , 2 ] . in this paper we intend to present our own experience in conducting diagnostics and treatment of penetrating neck traumas . from 1996 to 2012 , 10 patients with penetrating neck traumas were treated , including 3 females and 7 males . the age of the patients ranged from 16 to 55 ( the average age being 40.7 years ) . in 9 cases , wounds were inflicted with a knife ( 7 cut wounds , 2 stab wounds ) , and in 1 case it was a gunshot wound . knife wounds were single in 8 patients and multiple ( 34 stab wounds ) in 1 patient , including wounds to the chest and stomach . in 2 patients , injuries were due to suicide attempts , while the remaining ones resulted from crimes . according to the criteria laid down by rono and christiansen , zone i extends between the zygomatic cleft of the sternum and the lower edge of the cricoid cartilage . zone ii is the area between the lower edge of the cricoid cartilage and the line connecting both angles of the jaw . the area located above this line is zone iii of the neck . in our material , the injuries concerned mostly zone i ( 8 patients ) . in 2 cases , the injury involved zone ii . the only gunshot wound in the material was in zone i. among the observed symptoms , subcutaneous emphysema ( in 5 cases ) and bleeding from a wound ( in 3 cases ) were predominant . the patients characteristics are presented in table i. 
  characteristics of patients with penetrating neck trauma the time from receiving the injury to diagnosis ranged from 1 to 8 hours ( the average being 2.5 hours ) . in 5 patients , three patients with bleeding from the wound were operated on immediately . in 2 patients , the final diagnosis was based on computed tomography of the chest , revealing an upper mediastinal haematoma in one patient and a mediastinal haematoma with an associated left pleural haematoma in the other one . indications for surgery included increasing subcutaneous emphysema in 5 patients , bleeding from the wound in 3 patients , and mediastinal haematoma in 2 patients . intraoperatively , tracheal injury was found in 6 patients , carotid vessel injury in 3 patients , laryngeal injury in 2 patients , thoracic vessel injury in 2 patients , oesophageal injury in 1 patient , and thyroid gland injury in 1 patient . a surgical access through the revision of the wound trauma was performed in 8 cases . in 1 case , a longitudinal sternotomy and , in another case , the damaged larynx and trachea were supplied with single stitches and the oesophagus received two layers . the area of the stitches was covered with surrounding tissues . in the patient with the mediastinal haematoma , a median sternotomy was performed , revealing the damage of the brachial - cranial stem . the patient with the gunshot wound , suffering from mediastinal haematoma and left pleural haematoma , was opened through left - sided thoracotomy . massive bleeding from the disrupted aorta was found , which could not be dressed . treatment of patients with penetrating neck trauma in 9 patients , good treatment results were obtained . follow - up bronchoscopy did not show any changes in the place of tracheal sewing . penetrating neck wounds account for about 5 - 10% of all patients admitted due to injuries . the complicated anatomy of the neck and the location of very important vital structures on a small surface make the evaluation of damage and indications for surgical intervention difficult [ 3 , 4 ] . the gravity of the problem is increased even more by the fact that the mortality from injuries to this area may reach as much as 11% [ 1 , 4 ] . mortality depends on the neck zone exposed to injury and the type of tool inflicting the injury [ 4 , 5 ] . mortality from penetrating neck trauma in zone i is estimated at 12.1% , in zone ii at 7% , and in zone iii at 8% [ 3 , 6 , 7 ] . table iii presents data of various authors illustrating the relationship between mortality and type of tool ( guns , sharp tools ) used by the person inflicting the wound . the table shows the significantly higher mortality rate of gunshot wounds compared to stab wounds . there is a particularly high mortality rate for gunshot wounds of zone i of the neck . in our material mortality in stab and gunshot wounds of the neck in reports of various authors 
  in the study presented by nason et al .   and carried out on 134 patients , 95% of the patients had stab wounds and only 5% had gunshot wounds . the data on crime are completely opposite in the usa , where the percentage of neck gunshots was as high as 50% . victims of penetrating neck trauma suffer serious life - threatening damage to the structures running there . mcconnell and trunkey   emphasize the higher incidence of respiratory and digestive tract injures compared to those of vascular and nerve structures in penetrating neck trauma . an important factor determining the patient 's survival is his fast transport to the hospital . it is estimated that about 30 - 80% of patients with respiratory tract injuries die during transport to the hospital . the main symptoms of respiratory tract damage in neck injuries include subcutaneous emphysema and respiratory failure requiring intubation of the patient and ventilation replacement already during transport to the hospital [ 9 , 10 ] . based on 10 years of research , argood et al . determined factors that may influence complications in patients with injuries to the larynx and the neck part of the trachea . they include : delay in diagnosis , type of neck injuries , presence of other associated damage . the  gold standard  in the diagnosis of injuries of the respiratory tract is bronchoscopy . bronchoscopy allows one to evaluate the location and extent of the damaged area [ 9 , 11 ] . believe that the common use of bronchoscopy enables the prevention of delay in diagnosis and avoidance of treatment failures . in half of our patients , we performed bronchoscopy revealing damage to the respiratory tract . indications for surgical interventions in neck injuries include : active bleeding , haematoma or haemorrhagic shock , presence of blood in the respiratory and digestive tracts , respiratory failure , subcutaneous emphysema , neurological symptoms . 
  active bleeding , haematoma or haemorrhagic shock , presence of blood in the respiratory and digestive tracts , respiratory failure , subcutaneous emphysema , neurological symptoms . in our patients , increasing subcutaneous emphysema was the main indication for performing surgery ( fig . 1 ) . mediastinal bleeding and haemothorax constituted the other half of the indications ( fig . subcutaneous and upper mediastinal emphysema woman , 34 year , with disrupted aorta . left hemothorax and shot in the pleural cavity until recently , in many centres , the review of all penetrating neck traumas was considered mandatory . supporters of this tactic put forward an argument of the high risk of omission or delay in diagnosing patients , which may have fatal consequences . opponents of the selective observation of patients put forward an argument of the high percentage of negative neck revisions we think that a surgical intervention is required only in those patients who meet the indications . based on the acquired experience , we believe that an early and fast diagnosis can determine indications for surgery and prevent severe fatal complications .
aim of the studyaim of the study is to present our own experiences in the treatment of people suffering from penetrating neck traumas.material and methodsin the years 1996 - 2012 , 10 patients with penetrating neck traumas were treated , including 3 women and 7 men . 
 the patients age ranged from 16 to 55 ( the average age being 40.7 years ) . in 9 cases 
 the wound was caused by cutting or stabbing , while in one case it was inflicted by a gunshot . in 8 patients it was a single cut wound , while one patient suffered from 34 stab wounds to the neck , chest and stomach . 
 two cut wounds resulted from a suicide attempt . 
 the remaining injuries were the result of a crime.resultsall patients underwent immediate surgery , which involved revision of the neck wounds in 8 cases , one longitudinal sternotomy and one left - sided thoracotomy . 
 the indications for surgery included increased subcutaneous emphysema in 5 patients , bleeding from the wound in 3 patients , and mediastinal hematoma in 2 patients . 
 the damage assessed intraoperatively included tracheal damage in 6 patients , damage to carotid vessels in 3 patients , larynx in 2 patients , thoracic vessels in 2 patients , oesophagus in 1 patient and thyroid gland in 1 patient . in 9 patients , 
 the treatment yielded positive results . 
 the patient with a gunshot wound died during the surgery due to massive bleeding from the aorta.conclusionsin patients with penetrating neck wounds , early and rapid diagnostics allows one to determine the indications for surgery and prevent serious fatal complications .