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[The characteristics and management of shotgun wounds of the extremities].

OBJECTIVE
To discuss the characteristics, classification and the problem of management for shotgun wounds of the extremities.


METHODS
82 shotgun wounds of the extremities, classified according to the modified rule form Sherman and Ordog's, were treated by "incision and drainage" initially, and were closed in primary, delay and later phase. The fractures were fixed by plaster, external fixator, simple internal fixator or plate fixation. Vascular injury was repaired by suture end-to-end or autograft. The injured nerves were treated in the primary or later period.


RESULTS
The rate of infection was the highest in the primary closed wound, and the healing time was the longest in the later closed wound. The rate of infection was much higher in the fracture fixed by plate than the others. The results of nerve recovery in primary repair were not significantly different (except 2 case infection) from those in the later repair.


CONCLUSIONS
A significant difference was noted between shotgun wound and other wound. Removal of wadding, prevention of fascial compartment syndrome, repeat planned exploration of wound, proper wound closing, external fixation of fracture, vascular debridement before anastomosis and delayed nerves repair contribute to a successful outcome in patients with extremity shotgun wounds.