External wound zone lacks predictive value for internal injury site in penetrating neck trauma: A prospective analysis

Objectives: To prospectively evaluate the correlation between the anatomical zone of the external wound and the location of internal injuries in patients undergoing exploration for penetrating neck trauma (PNT) in Sana’a, Yemen. Methods: We prospectively enrolled patients presenting to teaching hospitals in Sana’a (January 2020–April 2021) with PNT who required neck exploration. The collected data included demographics, injury mechanisms, clinical presentation, imaging findings, intraoperative findings (external wound zone vs. internal injury site), and outcomes. Correlation was defined as an internal injury occurring within the same anatomical zone as the external wound. Statistical analysis was performed using Chi-square or Fisher’s exact test (p < 0.05). Results: Fifty-five male patients (mean age, 30.0 ± 9.2 years) were included. Gunshot wounds were the most common mechanism (61.8%), and most external wounds were located in Zone II (90.9%). Internal injuries were correlated with the external wound zone in 33 (60.0%) patients, whereas 22 (40.0%) had internal injuries in a different zone (most often inferior). No statistically significant association was found between the external wound zone and internal injury site (p = 0.208) or when analyzing specific zones or injury mechanisms (p > 0.05). Computed tomography angiography (CTA) was performed in 85.1% of patients. Morbidity occurred in 32.7% of the patients, with a mortality rate of 1.8%. Conclusion: The anatomical zone of the external wound demonstrated a poor correlation and no statistically significant association with the site of internal injury in this cohort of patients with PNT requiring exploration. These findings challenge the utility of the traditional zone-based approach in guiding patient management. Patient hemodynamic status, clinical signs, and selective imaging (particularly CTA) appear to be more reliable determinants for intervention, supporting a “no-zone” management strategy.