High velocity gunshot injuries to the extremities: management on and off the battlefield

Penn-Barwell, Jowan G.; Brown, Katherine E.; Fries, C. Anton

doi:10.1007/s12178-015-9289-4

Cited by 43 publications

(30 citation statements)

References 28 publications

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“…The first step includes bleeding control, systematic antibiotics therapy, and infection control by serial debridement; in contrast, the last step involves bone fixation and closure of the defect by soft tissues. [6] Moreover, such injuries can be frequently associated with major fractures (48%), impairment of soft tissue integrity (59%), vascular injuries (35%), and nerve damage.…”

Section: Discussionmentioning

confidence: 99%

Delayed bipedicled flap: An alternative and new method for reconstruction of distal leg defect after gunshot trauma: A case report and review of the literature

Yıldırım

İğde²,

Öztürk³

et al. 2017

Ulus Travma Acil Cerrahi Derg

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Shotgun injury is a trauma that leads to soft tissue defects, in which important structures such as the tendon and bone are exposed with fractures in the distal lower extremity. Because this region has insufficient soft tissue support, local flap options are highly limited. Although the most suitable options are free or perforator flaps for contemporarily reconstructing that region; owing to such highenergy traumas, the available local flaps are becoming more suitable. Besides having various advantages, bipedicled flaps are commonly used for reconstructing small-and medium-sized lower extremity defects. This study aimed to discuss the use of a delayed bipedicled flap, which has not been previously described in the literature.

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Section: Discussionmentioning

confidence: 99%

Delayed bipedicled flap: An alternative and new method for reconstruction of distal leg defect after gunshot trauma: A case report and review of the literature

Yıldırım

İğde²,

Öztürk³

et al. 2017

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…High velocity weapons have greater kinetic energy and consequent potential to destroy tissue as a result of the temporary cavitation induced once the bullet becomes deformed. Bullet fragmentation and bony fractures are predictors of increased wound severity whereas low velocity bullet causes damage limited to the bullet's path mainly as a result of localized crush injury [18,19]. The distance from the source of weapon and the intervention done had no statistical significance on the outcome.…”

Section: Discussionmentioning

confidence: 99%

Civilian Gunshot Injuries: Experience from Sokoto, North-West, Nigeria

Oboirien¹,

Sp²

2016

J Trauma Treat

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Introduction: The Proliferation of small arms in the West African sub-region and the activities of insurgent groups and rustlers have caused renewed interest in Gunshot injuries. We aim to document the trend and outcome of such injuries in our sub-region. Methods: It was a prospective study of cases of gunshot injuries admitted at the University Teaching hospital over a period of 18 months. Parameters analysed included patients' bio-data, region of the body affected, mechanism and source of projectile, clinical presentations and short term outcome. Statistical analysis was done with IBM SPSS 20. Level of significance was p<0.05. Results: A total of 43 patients were seen with a mean age of 33.76 ± 10.59. There were 42(97.7%) males and 1(2.3%) female. The victims were mostly farmers (25%), professional drivers (13.6%), Students (11.4%). The body region affected were the lower extremity (36.4%), upper extremity (27.3%), Most of the cases were from armed robbery attack (77.3%) and Assaults (13.6%). Low velocity weapons like Dane guns were the common sources of projectile 95.3%. High velocity weapon like AK 47 was used in 4.7% of cases. Majority of victims were shot at closed range (86.4%) and 79.5% were stable on presentation. Intervention carried out included wound debridement (65.9%), external fixation (23%), and chest tube drainage (9.1%). The outcome was such that 68.2% survived without residual deficit while 31.8% survived with residual deficit. Conclusion: Gunshot injuries were mainly from armed robbery attack using low velocity weapon with farmers being the most victims. Strict regulations in the acquisition and use of light firearms would reduce the incidence of armed robbery and gun related violence in our sub region.

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“…Compression of the disrupted vessels, tamponade and haemostasis then becomes a problem. The cavity needs to be packed and compressed to achieve adequate pressures, ideally with a haemostatic agent 10. We can again improvise: tampons can be used to pack wounds.…”

Section: Circulationmentioning

confidence: 99%

Improvised first aid techniques for terrorist attacks

2018

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Terrorist acts occur every day around the world. Healthcare professionals are often present as bystander survivors in these situations, with none of the equipment or infrastructure they rely on in their day-to-day practice. Within several countries there has been a move to disseminate the actions to take in the event of such attacks: in the UK, , and in the USA, This paper outlines how a very basic medical knowledge combined with everyday high-street items can render highly effective first aid and save lives. We discuss and summarise modern improvised techniques. These include the ABCDE approach of treating catastrophic haemorrhage before airway management, bringing together improvised techniques from the military and wilderness medicine. We explain how improvised tourniquets, wound dressings, splinting and traction devices can be fabricated using items from the high street: nappies, tampons, cling film, duct tape and tablecloths. Cervical spine immobilisation is a labour-intensive protocol that is often practised defensively. With little evidence to support the routine use of triple immobilisation, this should be replaced with a common sense dynamic approach such as the Montana neck brace. Acid or alkali attacks are also examined with simple pragmatic advice. Analgesia is discussed in the context of a prehospital setting. Pharmacy-obtained oral morphine and diclofenac suppositories can be used to treat moderate pain without relying on equipment for intravenous/intraosseous infusion in prolonged hold situations. The differentiation between concealment and cover is summarised: scene safety remains paramount.

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High velocity gunshot injuries to the extremities: management on and off the battlefield

Cited by 43 publications

References 28 publications

Delayed bipedicled flap: An alternative and new method for reconstruction of distal leg defect after gunshot trauma: A case report and review of the literature

Delayed bipedicled flap: An alternative and new method for reconstruction of distal leg defect after gunshot trauma: A case report and review of the literature

Civilian Gunshot Injuries: Experience from Sokoto, North-West, Nigeria

Improvised first aid techniques for terrorist attacks

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