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Any violation of the platysmal muscle ought to be an alert to the potential for grave injury to the contents of the neck. If the platysma is violated, decide whether the wound lies anterior (anterior triangle) or posterior (posterior triangle) to the sternocleidomastoid muscle, and decide in what zone the damage is found. Attempt to specify the direction of the wound tract (eg, toward or away from the midline or clavicle). About 50% of cases of penetrating neck trauma by which the platysma is violated haven’t any further damage.
If the platysma is clearly not violated by a penetrating injury, the patient could be safely cleared of a significant underlying damage. Smooth signs, resembling a nonexpanding hematoma and paresthesias, do not improve the predictive value of an arterial damage greater than indicating the proximity of the wound to a serious vessel. Smoking leads to premature aging of the skin. It damages the collagen and elastin fibers and makes the skin liable to early wrinkles and tremendous lines.
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