Ignatiadis Ioannis A, Mavrogenis Andreas F, Igoumenou Vasilios G, Polyzois Vasilios D, Tsiampa Vasiliki A, Arapoglou Dimitrios K, Spyridonos Sarantis
Department of Upper Limb and Hand Surgery and Microsurgery, KAT Hospital, Athens, Greece.
First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
Eur J Orthop Surg Traumatol. 2019 Feb;29(2):295-305. doi: 10.1007/s00590-018-2350-4. Epub 2018 Nov 29.
Gunshot wounds and blast injuries constitute a major public health problem, as the increasing availability of firearms and explosives in conjunction with increasing violence in the city setting have brought this reality into civilian life. Extremities are most commonly involved; therefore, orthopedic surgeons should be trained to manage these types of injuries. Complete and accurate assessment of the injury itself is of great importance, as it will determine the severity and the risk of patients. High-risk injuries from missiles and injuries from explosions are associated with moderate or poor outcomes, major complications, and increased need for multiple surgical procedures. On the other hand, low-risk injuries frequently present optimal results and rather low morbidity. The role of microsurgery is essential, especially in the high- and very high-risk injuries, since complex and multiple reconstructions have to be performed, which include the utilization of free flaps, nerve grafts, and tendon transfers.
枪伤和爆炸伤构成了一个重大的公共卫生问题，因为城市环境中枪支和爆炸物的可得性不断增加，再加上暴力事件日益增多，已使这一现实情况进入了平民生活。四肢是最常受伤的部位；因此，骨科医生应接受处理这类损伤的培训。对损伤本身进行全面、准确的评估至关重要，因为这将决定患者的严重程度和风险。导弹造成的高风险损伤和爆炸伤往往预后中等或较差，会出现严重并发症，且需要多次外科手术的情况增多。另一方面，低风险损伤通常预后良好，发病率也较低。显微外科手术的作用至关重要，尤其是在高风险和极高风险损伤中，因为必须进行复杂的多次重建手术，包括使用游离皮瓣、神经移植和肌腱转移。
