Peripheral vascular injuries from plastic bullets in children

Area of Science:

• Trauma Surgery
• Pediatric Vascular Surgery
• Ballistics Trauma

Background:

• Plastic bullets, introduced to reduce mortality in civil unrest, pose a significant risk of vascular injury in pediatric populations.
• Vascular trauma in children and adolescents presents unique challenges compared to adult injuries.

Purpose of the Study:

• To analyze the incidence and outcomes of lower extremity vascular injuries caused by plastic bullets in pediatric patients.
• To evaluate the effectiveness of surgical repair techniques in managing these specific injuries.

Main Methods:

• Retrospective review of 15 pediatric patients (<20 years) with lower extremity vascular injuries from plastic bullets over an eight-month period.
• Surgical repair of injured vessels, including primary repair and reversed saphenous vein interposition grafts for arterial injuries.
• Assessment of limb salvage and functional outcomes, including distal pulse palpation during follow-up.

Main Results:

• Fifteen patients sustained injuries to 23 vessels, with varied patterns of arterial, venous, or combined injuries.
• All arterial injuries were surgically addressed, resulting in a 100% limb salvage rate and no deaths.
• Eighty percent of patients exhibited palpable distal pulses post-treatment, indicating successful vascular reconstruction.

Conclusions:

• Plastic bullets are a source of serious pediatric vascular trauma, necessitating specialized management.
• Established adult vascular repair techniques are effective and applicable to pediatric vascular injuries.
• Successful treatment of low-velocity gunshot vascular injuries in children is achievable in resource-limited settings with skilled general surgeons.