High-velocity facial gunshot wounds: multidisciplinary care from prehospital to discharge

Abstract

A case is presented in which a high velocity rifle (shotgun) was fired into the inferior part of a patient's face in an attempted suicide causing widespread trauma to the inferior and left side of the patient's face. He presented to his general practitioner where an ambulance was called. The patient is followed from prehospital care (air ambulance) to resuscitation in accident and emergency and through the first stages of reconstructive surgery. The article focuses on the multidisciplinary approach to the patient's prehospital care and initial resuscitation at a major trauma centre. CT reconstruction images of the patient's skull allow visualisation of the extent of bone damage at presentation. Medical photography allows visualisation of the extent of the initial damage and shows how reconstructive surgery was undertaken early and in progressive stages. A literature review was performed allowing discussion of the current evidence and best practice in the management of facial gunshot wounds.

Gunshot injury to the face: a case report

“…There is an increasing incidence of GSIs worldwide, particularly those involving the face. [1][2][3] The extent of damage is dependent on a number of factors including the magnitude of energy transferred, distance travelled by the missile, type of bullet, and the anatomical structures encountered. High-energy transfer gunshots fired at close range inflict the most damage.…”

Ballistic projectiles removal in head and neck region

“…In this sense, the trauma pattern of PAF wounds is extremely variable, and can be classified as: penetrating, in which the projectile remains lodged in the injured tissue, usually caused by low-velocity projectiles (less than 1000 feet/s); perforating, where there is an entry wound and an exit wound; or avulsive, which involves tissue loss, and the latter is usually caused by high-velocity projectiles (more than 2000 feet/s) [1,2,[6][7][8]12,13].…”

“…The initial care of patients with a PAF injury in the head and neck region should focus on the ABCDE of the Advanced Trauma Life Support (ATLS), prepared by the American College of Surgeons, with special emphasis on the establishment of the respiratory tract, and bleeding control and recovery of the hemodynamic state, because the bleeding from the wound and subsequent edema can lead to significant respiratory tract damage, where the loss of large amounts of blood can also cause hypovolemic shock [1,2,6,13].…”