Vascular injuries of the base of the neck and thoracic inlet are one of the most formidable of all types of injury. Standard policy dictates routine exploration of all penetrating wounds of the neck, while conservative management is the general rule for penetrating injuries of the chest. A dilemma is encountered when the injury involves the "no man's land" between the two. One does not wish to commit the patient to the morbidity of thoracotomy when there is no significant injury, yet conservatism has been the primary factor in the high mortality from this type of injury. We have recently reviewed our experience with penetrating wounds of the neck. In this group of 146 cases, 14 patients had penetrating injuries of the great vessels emanating from the aortic arch. In most of the patients the proper approach was utilized and the injuries were exposed and readily repaired. In others the