A prospective, randomized clinical trial of wound debridement versus conservative wound care in soft-tissue injury from civilian gunshot wounds.

While clear-cut evidence exists documenting the extensive tissue destruction from blast and cavitation in high-velocity projectile injury and that wounds from projectiles of all velocities can be contaminated by bacteria potentially leading to infection, less is known about the tissue effects of lower-velocity projectile injury from gunshot wounds seen in the civilian sector. Despite this, traditional recommendations have supported debridement, admission, and aggressive wound care in these patients. This study will determine the effect of two methods of wound care on the outcome of soft-tissue gunshot wounds. Patients who had suffered a gunshot wound and were transported to the Trauma Center at the University of Florida Health Science Center postinjury were considered eligible for this study. All patients with torso injury, skeletal injury, neurovascular injury, or vascular proximity were excluded. Patients were then randomized to two treatment regimens based on a previously determined scheme. All wound care, follow-up, and healing evaluations were performed by the same individual. A total of 163 patients met the study criteria and they were randomized to the two treatment regimens: 89 patients, debridement and wound care; 74 patients, wound care alone. Each group was similar in age, sex, time to treatment, and caliber/velocity. Patients available for follow-up were similar in each group. Four patients in the wound-debridement group and two patients in the conservative wound-care group developed superficial infections. All infections responded to prompt local therapy. This study supports the conservative treatment of soft-tissue injury from low-velocity gunshot wounds.