[Effect of rays of monochromatic red light on stimulation of the wound process in gunshot wound].
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Animals↗
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Results for “Wounds, Gunshot”
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Conservative treatment of low velocity gunshot wounds.
A retrospective study of gunshot wounds of the extremities present 148 patients who had sufficient clinical and radiological follow-up data to assess the results. The routine treatment for this injury consisted mainly of cleansing the wound, introduction of systemic antibiotics in the emergency room followed by hospitalization. More extensive treatment and surgical debridement were done only when intraarticular or vascular injury occurred. Two patients developed infected wounds. In 6 displaced humeral shaft fractures, there were 2 non-unions and one delayed union. In 11 comminuted, displaced fractures of the femoral shaft, one non-union occurred.
Aged↗
Gunshot wounds of the abdomen. A review of 277 cases.
During a five-year period from July 1968 throuhgh June 1973, 277 abdominal gunshot wounds (GSWs) occurred, the overall fatality of which was 10%. Abdominal exploration was done in all patients. No intra-abdominal injury was found in 40 patients (14%) and no death occurred in this group. There were 28 fatalities (12%) in 237 patients (86%) who had intra-abdominal injuries. Morbidity and mortality were related not only to the number of organs injured, but also to specific organs injured. The leading cause of early death was hypovolemia due to major vessel injuries. Septicemia was the most common cause of death if the patient survived the first 24 hours of hospitalization. Penetrating abdominal stab wounds and gunshot wounds must be considered separately, and mandatory routine abdominal exploration for all penetrating gunshot wounds is advised. In stab wounds to the abdomen, conservative management may be preferable.
Abdominal Injuries↗
[Gunshot wounds from steel ball fragments].
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Blast Injuries↗
Gunshot wounds of the suprarenal abdominal aorta.
Four cases of gunshot wounds to the suprarenal abdominal aorta are described. All required prosthetic graft replacement including one or more visceral arterial branches. Two patients survived. Factors important in survival were rapid transportation permitting early resuscitation and retroperitoneal tamponade which delayed exsanguination and permitted stabilization with systematic management. The major problem in management of gunshot wounds of the suprarenal abdominal aorta is limitation of visceral ischemia, particularly hepatic and renal. Special adjuncts such as local renal hypothermia, as used in these cases, or bypass techniques are necessary and should be available before exploration of a periaortic hematoma due to gunshot wound in this area.
Abdominal Injuries↗
Diagnosis and management of abdominal gunshot wounds during pregnancy.
The literature on gunshot wounds of the gravid uterus is reviewed, and three new cases reported. Clinical management is discussed, with emphasis on the condition of the abdominal wall and other connective tissue during pregnancy, the contraindications for paracentesis, the changes during pregnancy in blood volume, central venous pressure, white blood count, and GI and GU tracts, and indications for celiotomy or cesarean section.
Abdominal Injuries↗
Gunshot wounds of the esophagus.
During a 4 year period between 1970 and 1974 there were eleven esophageal gunshot wounds representing 52 per cent of the total esophageal perforations. The increased incidence of esophageal gunshot wounds reflects the higher rate of civilian gunshot injuries. There were six perforations in the cervical portion of the esophagus and five in the thoracic portion, with three located above the aortic arch, one in the midesophagus, and one in the lower third. Symptoms are less diagnostic than in esophageal perforations from other causes because the gunshot wound tends to mask the complaints related to mediastinitis. The signs are similar. In 9 patients free air was present in the neck or mediastinum and in 10 patients the diagnosis was confirmed by barium swallow. Of the 2 patients without free air, one had a lateral thoracic wound and esophageal injury was not suspected; the diagnosis was made by drainage of oral feeding through a thoracostomy and confirmed by barium swallow. In the other patient the perforation was found during surgery for hemothorax. Primary repair with drainage was done in the group with cervical injuries. All survived with no serious complications. In the group with thoracic injuries, fistulas developed in 2 of 3 patients who had primary repair with drainage. Two patients with extensive injuries of the esophagus treated by defunctionalization did well but required a second procedure. It is concluded that gunshot wounds of the cervical esophagus, if treated promptly by suture and drainage, will do well. Thoracic injuries represent a more difficult problem and it is suggested that defunctionalization of the esophagus is the safest procedure, particularly if damage is extensive.
Abscess↗
Low-velocity gunshot wounds to the maxillofacial complex.
A review of the past literature of gunshot wounds indicates that the clinical material deals mainly with high-velocity missile injuries from military experience. A series of 66 cases of low-velocity gunshot wounds to the maxillofacial complex at San Francisco General Hospital between 1971 and 1978 indicates a clinical difference between injuries caused by low-velocity as compared to previously reported high-velocity missiles. Damage to vital structures resulting from missile injury to the maxillofacial complex are classified in three anatomic areas: 1) supra-orbital (28 cases of which 20 involved neurological damage); 2) mid-face (24 cases of which 8 involved the orbits and/or globe); 3) lower face (14 cases, of which 3 involved laceration of the carotid and 2 involved airway obstruction necessitating tracheostomy). The management of gunshot wounds to the maxillofacial area is outlined, emphasizing: 1) Debridement and prompt closure of intraoral wounds with antibiotic coverage: 2) Early stabilization of mandible fractures: 3) Indications for tracheostomy; 4) Arteriographic studies. In our series there were only four infections, which were treated easily with incision and drainage and appropriate antibiotic selection.
Airway Obstruction↗
[Gunshot wounds of the arteries].
The surgical tactics for the treatment of gunshot wounds of vessels should depend not only on the kind of the injuring shell but also on the concrete dimensions of the injury of vessels and surrounding tissues. The vital capacity of the vessels and adjacent tissues should be determined by the same criteria as that of well-known and sufficiently studied gunshot wounds.
Amputation, Surgical↗
Management of low-velocity gunshot wounds of the hand.
Of 41 consecutive patients with low-velocity gunshot wounds to the hand, 28 were treated by superficial debridement of wound edges and 13 were treated by meticulous debridement and exploration under operating room conditions. All patients received antibiotics. All wounds were closed primarily. Some had small drains for 24 to 48 hours. There were no complications of exploration. Of the 28 patients whose wounds were not explored, 16 had complications or residual deficits that required exploration. Hospital stay of the two groups was similar. Surgical exploration of low-velocity gunshot wounds to the hand is recommended.
Adolescent↗
Computerized tomographic scan and gunshot wounds of the head: indications and radiographic findings.
The authors document their experience with the computerized tomographic (CT) scanner for evaluating gunshot wounds of the head. Only those patients who were considered to be operative candidates and who were neurologically stable were scanned. In the postoperative period, patients who were not scanned preoperatively and those whose condition did not improve were also scanned. In the preoperative period the CT scanner is useful for identifying and localizing missile tracks, bony and metallic fragments, intra- and extraparenchymal hematomas, intracranial air, and brain swelling. In the postoperative period the CT scanner may demonstrate retained bone fragments, edema, brain abscess, and intracranial air. The limitations of the CT scan in evaluating gunshot wounds include an inability to define vascular lesions suchas traumatic aneurysms and post-traumatic spasm. Metallic scatter from missile fragments may render certain CT cuts uninterpretable. In addition, the CT scan may appear minimally abnormal in spite of immediate and irreversible injury caused by a shock wave transmitted to brain stem structures. The CT scanner has superceded angiography as a diagnostic tool for evaluating gunshot wounds of the head because it is noninvasive and rapid, allows visualization of the entire head, can resolve very small lesions that produce little or no mass effect, can help to determine the nature of intracranial lesions and may quantitate the amount of hemorrhage and edema. Because it enables physicians to visualize intracranial structures in three dimensions, the CT scan may precisely define missile tracks and contiguous lesions in a manner not heretofore possible with other diagnostic modalities. Thus, it is invaluable for the rational planning of surgical therapy.
Brain Injuries↗
Reappraisal of low-velocity gunshot wounds of the aorta and inferior vena cava in civilian practice.
Eighteen low-velocity gunshot wounds of the abdominal aorta and inferior vena cava were analyzed. Injury to the aorta and inferior vena cava occurred in 9.2% of all penetrating abdominal injuries due to gunshot wounds in our series. The mortality rate was 33% for the suprarenal and 25% for the infrarenal inferior vena cava, 50% for the infrarenal aorta, 100% for the suprarenal aorta and for the combined injuries. Control of active bleeding is more closely related to survival than any other single factor.
Adult↗
A review of 158 gunshot wounds to the chest.
One hundred and fifty-eight gunshot wounds to the chest treated at the Royal Victoria Hospital, Belfast, between August 1969 and July 1976 are reviewed. The place of open operation in the treatment is discussed.
Female↗
Early intracranial pressure studies in gunshot wounds of the brain.
Intracranial pressure (ICP) was recorded following gunshot wounds of the brain in 20 patients, and in 11 of them within an hour of injury, during resuscitation. In six who were bleeding profusely, both ICP and blood pressure were low, and they required massive transfusion, with successful outcome in two. Four others presented with small wounds and high ICP. Others, with minimal damage, had "normal" pressures, but this could be affected adversely by coughing, struggling, and minor degrees of respiratory obstruction. Immediate endotracheal intubation, muscle relaxation, and mechanical ventilation prevented such deterioration. Controlled ventilation was continued postoperatively and seemed to control ICP in survivors. It is suggested that the very labile post-traumatic condition of such patients can be improved by adequate resuscitation, immediate intubation, and controlled ventilation; ICP monitoring is valuable pre- and postoperatively in assessing treatment.
Brain Injuries↗
Transabdominal gunshot wounds of the hip.
Experience with two cases of transabdominal gunshot wounds of the hip in nonmilitary circumstances indicated delayed recognition of the hip involvement. This delay resulted in compromised end results in both cases. The wartime principles of early recognition and prompt surgical management are recommended for civilian settings.
Abdominal Injuries↗
Civilian gunshot wounds of the brain.
The authors report on 42 fatal gunshot wounds to the brain in civilians. The firearms used were those commonly available to civilians, ranging from a .22 revolver to a .45 semiautomatic pistol. Missle tracks were measured and the volume computed. The relatively low-velocity missles produced by these weapons to not create the devastation that characterizes wounds from high-velocity military firearms. Instead, there is much variation in the size of the missle tracks, and they cannot be directly related to caliber. Pressure marks and contusions, impaction of bone chips, internal richochet, and cerebral edema occurred frequently. The missle passed through the brain completely in very case but was retained by the skull or soft tissues in a large percentage of cases. The mechanism of death may be acute pressure on the brain stem from the passage of the missle through the brain.
Adolescent↗
Reconstruction of alveolar ridge and jaw defects resulting from gunshot wounds.
Reconstruction and rehabilitation of acquired defects of the oral cavity is an important dental service. Severe deformities of the jaws may result secondary to gunshot wounds of the oral-facial region. New advances in soft and hard tissue surgical reconstruction can be of great benefit to the patient when coupled with prosthetic rehabilitation. In recent years there has been a significant increase in the incidence of gunshot wounds in the civilian population in the United States, and those of the mouth and jaws are relatively common-place. Gunshot wounds to the face and jaws may cause gross destruction of tissues. Although immediate definitive treatment of wounds reduces the mutilating effect, a significant number of patients require extensive reconstructive procedures. In addition, prosthetic rehabilitation is almost always needed. The purpose of this paper is to briefly review some recent advances in reconstruction of the maxilla and mandible following gunshot injuries.
Alveolar Process↗