Tetanus status should be assessed in all patients with penetrating trauma The clinician should consider a broad-spectrum antibiotic for a patient with evidence of neck trauma, especially if esophageal or pharyngeal injury seems likely Placement of a nasogastric or an orogastric tube is controversial for the patient with cervical injury because it may worsen a pre-existing esophageal injury or dislodge clots in zone I of the neck When placed, these tubes should be well lubricated, inserted gently and slowly, and withdrawn if difficulty in passage or evidence of obstruction occurs Superficial abrasions, lacerations, and puncture wounds are common in children Wounds superficial to the platysma can be cleaned and sutured under local anesthesia in the ED Clean wounds can be sutured as late as 12 to 18 hours after the injury because of the excellent blood flow in the neck Closure after 72 hours is not recommended Penetration of the platysma is an indication for surgical referral and, in some cases, surgical exploration When neck wounds that penetrate the platysma are evaluated, exploration in the ED is discouraged because of the risks of clot dislodgment and venous air embolism Rapid surgical exploration and repair are indicated in patients struck by a high-velocity missile, those with unstable vital signs, uncontrollable bleeding, rapidly expanding hematomas, progressive airway compromise, worsening neurologic symptoms, increasing subcutaneous emphysema, or bubbling wounds ( Table 112.4 )