Arterial injuries in extremity shotgun wounds: requisite factors for successful management

The extremity shotgun wound presents a surgical challenge in the treatment of peripheral arterial trauma. Adherence to specific principles of management is required for optimal limb salvage. Thirty-four vascular injuries in 31 patients were reported. Arteriography is mandatory since the presence of distal palpable pulses was an unreliable indicator of the absence of arterial injury in 13 patients. Intraoperative arteriography was essential to demonstrate distal sequential injuries. Arterial reconstruction was necessary in 28 patients who sustained 31 significant vascular injuries. Autogenous interposition grafts were required in 10 patients. Seventeen patients underwent resection of the injured arterial segment followed by an end-to-end anastomosis. Arteriovenous fistulas were ligated in two patients, while two sidewall injuries were treated with lateral repair. Delay of operative intervention with subsequent infection, failure to reconstruct all vessels injured, and inadequate initial fasciotomy were factors that contributed to an amputation in two patients. Successful management of arterial injuries in extremity shotgun wounds requires attention to the following requisite factors: preoperative and intraoperative arteriography, prompt operative intervention, fracture stabilization, repair of all injured major vessels, use of autogenous graft tissue, venous reconstruction, thorough debridement, and fasciotomy. Twenty-nine of 31 patients retained a functional limb by adhering to these principles of management.