Shotgun injuries of the upper extremity

Although most reports of civilian gunshot injuries consist mainly of wounds inflicted by handguns, shotgun wounds deserve special consideration. Longrange shotgun wounds rarely pose a problem; however, medium- and close range wounds of the penetrating and perforating type may inflict substantial soft-tissue loss, bone defects and comminution, and loss of nerve and vessel continuity. Because of the complex and multiple system involvement by shotgun wounds, a greater challenge exists to obtain a successful, functional result. The challenge is most appropriately met by an aggressive approach of early operative exploration and debridement of the wound, internal stablization of the bony fragments, vascular repair when indicated, and exploration and identification of nerve deficits, followed by an early wound closure.