Management of community-based shotgun injuries of the extremities: impact of emergent vascular repair without angiography.

BACKGROUND

Shotgun injuries of the extremities create challenging problems for vascular surgeons. In this study, we retrospectively analyzed surgical results without preoperative angiography.

METHODS

Forty-nine patients with shotgun wounds who underwent vascular reconstruction in the extremities from 1999 to 2004 were retrospectively reviewed.

RESULTS

Vascular reconstruction of the extremities after shotgun injury differs from that following injuries caused by other firearms because of extensive tissue damage. In 19 patients, function of the extremity was unsatisfactory after one year; in 12 of them functional deficit was extreme, which was thought to be the result of nerve injury. After several interventions, 25 of 49 patients are well after one year under a rehabilitation program.

CONCLUSION

Based on these results, we favor immediate operative exploration of the extremities in patients with hard signs of vascular trauma, thereby minimizing the ischemic interval, and we recommend angiography only for elective operations. Early fasciotomy should be done without hesitation in patients with long ischemic periods and in those with combined arterial/venous injury.