Distal Lower Extremity Revascularization for Limb Salvage After Close Shotgun Injuries

Objective: Most of the time, amputation is unavoidable depending on the severity of the destruction in extremity injured by close range shotgun trauma. We hereby present our surgical results regarding a case series of patients in whom we performed limb salvage surgery for closerange, below-knee shotgun injuries. Material and Methods: This cross-sectional study was made between May 2012 and October 2013. Data regarding the patient demographics, operative parameters, and the post-operative course were prospectively collected by recording on a printed chart (9 patients). Results: All patients had fragmented tibial fractures, and 6 patients had also fibula fractures. The posterior tibial artery was the most commonly injured artery (8 patients). Five patients had double arterial and 4 patients had triple arterial damage. Four patients received primary revascularization to the extremity, 3 received autologous graft interposition with great saphenous vein, and 2 received distal bypasses with the popliteal artery being used as the inflow source. The nonviable soft tissue was removed. External fixation was performed for bone fractures. Injured nerves were primarily repaired. The median hospital stay was 11 days (8-15 days). Four patients achieved improvement in limb functions whereas the remaining 5 patients had permanent neurologic impairment during follow-up. Conclusion: Gunshot wounds causes lower extremity vascular injury associated with high risk of amputation if accompanied by severe bone fracture and soft tissue damage. Rapid diagnosis and early surgical intervention are essential to decrease the rate of amputation, and achieve a functional recovery. Reconstructive surgery may be successfully performed for patients who are under risk for probable amputation.