Improving outcome from extremity shotgun injury

The charts of 124 consecutive patients with extremity shotgun injuries managed over an 8-year period were reviewed to assess the results of a uniform protocol. This consisted of liberal use of arteriography, prompt exploration, wide debridement or fasciotomy, and frequent operating room dressing changes for large wounds. Thirty-three patients had arterial injuries and 16 had major venous injuries. Twenty patients had major soft tissue wounds and there were 15 significant long bone injuries. Results overall were excellent with over 95 per cent of patients retaining an intact and functional limb. Of the six limb amputations, three were done primarily and three were performed for late septic complications. Two of these late amputations were done following inadequate initial revascularization at referring hospitals. Early wound closure, liberal use of arteriography and fasciotomy, early fracture stabilization, and repair of all significant vascular injuries contribute to a successful outcome in patients with extremity shotgun wounds.