[Gunshot injuries in peacetime and their therapy]

Between 1976 and 1982 46 patients with gunshot injuries (43 m., 3 f.) were seen at the University of Heidelberg Department of Surgery. Frequent causes of injury in 42 adults (40 m., 2 f.) and 4 children (3 m., 1 f.) were suicide attempts (19) and carelessness in the handling of shotguns (11). Criminal offence was related to nine injuries; no retrospective classification of the event causing the injury was possible in further seven cases. Affected in descending order of frequency were brain and lung (10 each), soft tissue of thigh (9), intraabdominal organs (5), heart (4), liver and bone (3 each), blood vessels (2) and facial skull, penis, buttock, neck and mediastinum (1 each). Six patients suffered from combined injuries, in three cases a combined abdomino-thoracic injury was seen. Whilst suicidal injuries of the skull are related to poor prognosis, other peacetime gunshot wounds are less problematic when compared to military gunshot wounds due to the lower speed of the projectiles. Therapeutic procedures follow the general rules of open treatment of injuries including prophylaxis against tetanus and botulism as well as systemic antibiotic therapy. In general abdominal and abdomino-thoracic gunshot wounds as well as vascular injuries require immediate surgical procedure. In isolated thoracic injuries a conservative approach may be justified depending on the situation. The same rule applies to fractures caused by gunshots.