Peripheral vascular trauma from close-range shotgun injuries
J. P. Meyer, L. T. Lim, J. J. Schuler, J. J. Castronuovo, D. Buchbinder, G. F. Woelfel and P. Flanigan
This report summarizes an eight-year experience (1976 to 1983) with 49
close-range shotgun blasts with associated major vascular injuries seen in
a large urban hospital. Injuries to the upper extremity (40%), lower
extremity (56%), and neck (4%) were seen. A high frequency of associated
deep venous injury (82%), nerve injury (37%), fracture (33%), massive
soft-tissue loss (43%), and compartmental hypertension (39%) was observed.
There were no deaths in this series, and the limb salvage rate was 96%.
Neither patient with multiple carotid artery injuries suffered a neurologic
deficit. We attribute our success in the management of these complex
injuries to rapid fracture immobilization, early and aggressive use of
fasciotomy, adequate debridement of devitalized tissue, repair of deep
venous injuries, arterial repair with autogenous tissue, and extra-anatomic
bypass grafting in selected cases.
