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Improving outcome from extremity shotgun injury
J S Bender1, S M Hoekstra, M A Levison
1Department of Surgery, Detroit Receiving Hospital, Michigan.
The American Surgeon
|June 1, 1993
Summary
A uniform protocol for extremity shotgun injuries, including arteriography and debridement, resulted in excellent limb salvage rates. Over 95% of patients retained functional limbs, demonstrating the protocol
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- Extremity shotgun injuries present complex challenges.
- Effective management protocols are crucial for limb salvage.
Purpose of the Study:
- To evaluate the outcomes of a standardized management protocol for extremity shotgun injuries.
- To assess the efficacy of liberal arteriography, prompt exploration, and aggressive debridement.
Main Methods:
- Retrospective review of 124 patients with extremity shotgun injuries over 8 years.
- Analysis of a uniform management protocol including arteriography, debridement/fasciotomy, and wound care.
- Assessment of limb salvage rates and complications.
Main Results:
- Over 95% of patients retained intact and functional limbs.
- 33 patients had arterial injuries, 16 had major venous injuries.
- Six limb amputations occurred, three primarily and three due to late septic complications.
Conclusions:
- A uniform protocol involving early intervention and aggressive surgical management leads to excellent limb salvage in extremity shotgun injuries.
- Liberal arteriography, prompt exploration, debridement, fasciotomy, and fracture stabilization are key components.
- Inadequate initial revascularization at referring hospitals can lead to late amputations.