Management of community-based shotgun injuries of the extremities: impact of emergent vascular repair without angiography

BACKGROUND: Shotgun injuries of the extremities create challenging problems for vascular surgeons. In this study, we retrospectively analyzed surgical results without preoperative angiography.
METHODS: Forty-nine patients with shotgun wounds who underwent vascular reconstruction in the extremities from 1999 to 2004 were retrospectively reviewed.
RESULTS: Vascular reconstruction of the extremities after shotgun injury differs from that following injuries caused by other firearms because of extensive tissue damage. In 19 patients, function of the extremity was unsatisfactory after one year; in 12 of them functional deficit was extreme, which was thought to be the result of nerve injury. After several interventions, 25 of 49 patients are well after one year under a rehabilitation program.
CONCLUSION: Based on these results, we favor immediate operative exploration of the extremities in patients with hard signs of vascular trauma, thereby minimizing the ischemic interval, and we recommend angiography only for elective operations. Early fasciotomy should be done without hesitation in patients with long ischemic periods and in those with combined arterial/venous injury.

Ekstremitelerdeki toplumsal av tüfeði yaralanmalarý: Anjiyografi olmadan yapýlan acil damar tamirleri

AMAÇ: Av tüfekleri ile meydana gelen damar yaralanmalarý cerrahlar için ciddi sorunlar yaratýr. Bu yazýda, anjiyografi yapýlmadan cerrahi giriþim yapýlan av tüfeði yaralanmalarý
deðerlendirildi.
GEREÇ VE YÖNTEM: 1999-2004 yýllarý arasýnda av tüfeði ile meydana gelen ve vasküler tamir yapýlan 49 hasta geriye dönük olarak ele alýndý.
BULGULAR: Av tüfeði yaralanmalarý sonucunda meydana gelen damar travmalarý tamiri ciddi doku hasarý oluþmasýndan dolayý diðer ateþli silahlardan farklýdýr. Kýrk dokuz hastanýn 19’unda 1 yýl sonunda ekstremite fonksiyonu tatminkar deðildi. Bu hastalarýn 12’sinde tüm giriþimlere raðmen tam fonksiyon geri dönmemiþ ve sinir hasarýna baðlý olduðu düþünülmüþtür, 25 hasta ise kemik, tendon, sinir, cilt giriþimleri ile ve katý fizik tedavi programý ile 1 yýl sonunda tam fonksiyon kazanmýþtýr.
SONUÇ: Bu çalýþmada, av tüfeði yaralanmalarý ile meydana gelen vasküler hasarlarýn, belli ölçütler kullanýlarak ve anjiyografi yapýlmadan, kabul edilebilir risklerle tamir edilebileceði gösterilmiþtir.