散弾銃による銃創例の検討

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  • MANAGEMENT OF SHOTGUN INJURIES

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We treated a total of eight patients sustaining shotgun injuries over a 14-year period since the initiation of the Tokai University Hospital. All the patients were males and were shot accidentally. Treatment included hospitalization for observation and, where possible, the skin surrounding pellet wounds were shaved, washed and covered by sterile dressings. Two patients had chest tubes placed, one underwent craniotomy for ocular morbidity and one had extensive destruction of the knee joint and subsequently required partial resection of his femur and tibia. No death nor severe uncontrolled bleeding occurred. No exploratory thoracotomy nor laparotomy was performed suggesting pleural, mediastinal, or peritoneal penetration. One patient with wounds on his right hand developed soft tissue infection which responded favorably to the therapy, and other seven were well treated without infection. <BR>Complete removal of a lead slug is not the sine qua non in the treatment of gunshot wound, however, a bullet bathed in the synovial fluid or pseudocysts near the joint spaces should be removed, because lead is dissolved in this liquid, and the solute is deposited in the subsynovial tissues. Plumbism from retained bullets is a rare condition. <BR>No cases suspecting of plumbism has been seen in these patients even after the maximum follow up period of 13 years and 8 months.

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