Open Wound of the Neck

First aid for a neck wound

1. Call 911 for any deep wound, heavy bleeding or breathing problems.
2. Apply firm, direct pressure on the wound with a clean cloth or gauze using your hand. Keep pressing. Add more cloth on top if it soaks through rather than removing it.
3. Do not wrap a bandage tightly around the neck, which can block the airway or blood flow to the brain.
4. Cover large vein wounds with a hand or an airtight dressing (such as plastic) to prevent air being sucked in (air embolism), and keep the person lying flat or slightly head-down if possible.
5. Do not remove an impaled object. Stabilize it with padding.
6. Keep the head and neck still, especially after a fall, crash or blunt injury, because the spine may be injured.
7. If the person is breathing poorly or choking on blood, roll them onto their side while keeping the neck in line, if trained.

Why neck wounds are dangerous

The neck contains, within a few centimeters:

• carotid arteries and jugular veins
• vertebral arteries in the spine
• the larynx and trachea (airway)
• the pharynx and esophagus
• the thyroid gland
• nerves to the voice box, tongue, shoulder and arm
• the cervical spine and spinal cord

Injury to a large vessel can cause rapid blood loss and hemorrhagic shock. An opened vein can draw in air (air embolism). Artery injury can cause a stroke. Airway injury causes air under the skin and breathing problems, and esophageal injury can lead to deep infection.

Types of neck wounds

Doctors divide the neck into three zones from the collarbone to the jaw angle to plan investigations for penetrating injuries.

Redness around a neck wound

Some pink redness right at the wound edge is normal for a few days. Signs of wound infection or cellulitis:

• redness spreading outward, often more than about half an inch beyond the edge
• warmth, swelling and increasing pain after the first 2 to 3 days
• pus or cloudy discharge, or a bad smell
• red streaks
• fever or chills
• a tender, fluctuant lump (an abscess)

Infection in the neck can spread into the deep spaces of the neck, causing a deep neck infection with fever, neck stiffness, pain on swallowing or trouble opening the mouth. This needs urgent treatment.

How doctors assess neck wounds

• airway, breathing and circulation are secured first
• examination of the wound depth and signs of vascular, airway, digestive and nerve injury
• CT angiography of the neck for penetrating wounds in stable patients
• endoscopy or contrast studies for suspected esophageal or airway injury
• emergency surgery for "hard signs" such as active bleeding, expanding swelling, or air bubbling

Treatment

• minor wounds: cleaning with clean running water, removing debris, closing with stitches, staples, tissue glue or strips, and a dressing
• tetanus vaccination if not up to date (within 5 years for dirty wounds, 10 years for clean wounds)
• antibiotics for bites, heavily contaminated wounds, or signs of infection
• surgical repair of vessels, airway, esophagus or nerves for deep injuries
• follow-up for wound checks and stitch removal, usually after about 5 to 7 days on the neck

Home care for a minor neck wound

• keep it clean and dry for the first 24 to 48 hours, then wash gently
• apply petroleum jelly and a clean dressing
• protect the healing scar from the sun for several months to reduce darkening
• watch for signs of infection

Frequently asked questions

When is a neck wound an emergency?

A neck wound is an emergency if it is deep, from a knife, glass or gunshot, bleeds heavily, has a growing swelling, bubbles air, or causes difficulty breathing or swallowing, a hoarse voice, coughing blood, or weakness or numbness. Call 911 and apply firm pressure.

What does redness around a neck wound mean?

Mild pinkness at the edges in the first few days is part of normal healing. Redness that spreads outward, with warmth, swelling, pus, increasing pain or fever, suggests infection and needs medical assessment and possibly antibiotics.

How do you stop bleeding from a neck wound?

Press firmly and directly on the wound with a clean cloth or gauze and keep pressing. Do not wrap a bandage tightly around the neck. For heavy bleeding, call 911, keep the person lying down and still, and keep pressure on until help arrives.

Does a neck cut need stitches?

Cuts that gape, are deeper than the skin, longer than about half an inch, or will not stop bleeding usually need closure with stitches, glue or strips. Wounds are best closed within several hours. Deep or penetrating wounds need emergency assessment for internal injury.

How long does a neck wound take to heal?

Small cuts and scrapes usually heal in 1 to 2 weeks. Stitches on the neck are typically removed after 5 to 7 days. Scars continue to remodel and fade for many months. Deep injuries requiring surgery take longer, depending on what structures were involved.