The Early Treatment of Close-Range Shotgun Wounds to the Extremities

¹ From the Department of Orthopedic Surgery, University of Texas Southwestern Medical School, Dallas

Some of the elementary ballistics of the shotgun have been presented in the hope that an understanding of this weapon and the missiles it fires will aid in the surgical care of shotgun wounds.

Variations in the wounds inflicted with this weapon are described as well as the apparent differences in susceptibility of various tissues.

The necessity of suspecting the presence of wadding in close-range wounds and of removing it is stressed. The difficulty in closing the wound to be anticipated in most cases of shotgun-blast injury is also described.

From our brief experience recounted here, we would recommend thorough routine débridement; an extensive search for wadding in penetrating wounds, including a counter incision; and secondary wound coverage with split-thickness skin when granulation tissue has formed intact surfaces, all spaces are obliterated, and there is no drainage from the depths of the wound.

Exceptions will be encountered, notably in the hand, wrist, and possibly the forearm, where earlier closure must be attempted to preserve the function of multiple, closely arranged gliding structures.

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