This article reports the diagnosis and treatment experience of a case of open neck injury caused by nailing with perforation of the common carotid artery. A 34-year-old female patient came to the doctor because of "neck trauma for more than 4 hours". The preoperative neck CT showed that the iron nail penetrated into the right neck and accumulated air, which was closely related to the right common carotid artery. During the operation, it was found that the nail damaged the sheath of the vagus nerve and passed through the middle of the right common carotid artery. The nail penetrated the injured right anterior scalene muscle, and the nail tip was embedded in the right transverse process of C5. The cervical plexus was not obvious damage. The neck injury and the perforated common carotid artery were repaired through multidisciplinary surgery. The patient recovered well after operation without obvious complications.