Gunshot wounds of the chest]

A generalized experience with treatment of more than 1000 patients with wounds of the chest is presented. Bullet wounds prevailed. Methods of treatment of penetrating wounds of the chest are described.     

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.     

Gunshot wounds of the ureter]

Lesions of the ureter caused by penetrating wounds of the abdomen rare a are complication of abdominal gunshot wounds, of which the reported incidence is 2 to 17%. The preoperative diagnosis is difficult and unrecognized initially in every third case. There are no early clinical signs of ureteral lesions. There is often no hematuria. Only IVP can make the preoperative diagnosis possible. As a matter of fact, the diagnosis will often be established by the surgical exploration made during the laparotomy required by the extent of the associated lesions. The ureteral blast contusion is an important cause of secondary necrosis with fistula. The treatment is mainly based on ureteroureterostomy after debridement. The transanasmotic drainage of urine is controversial. Mortality results from associated abdominal lesions and morbidity consists in a risk of secondary nephrectomy.     

Gunshot wounds of the foot

It is imperative that the physician participating in the care and treatment of foot and ankle trauma appreciate the epidemiology, the unique characteristics, and principles of treatment of gunshot injuries involving the foot and ankle. The current author will provide the reader with knowledge of how the bullet velocity, its mass, and its area are important in determining the energy transmitted to the tissues struck by the bullet. These forces imparted by the projectile interact with the specific characteristics of the tissues to determine the nature and extent of the trauma sustained by the foot and ankle. An understanding of the appropriate grading of the injury will allow for a rationale approach to the treatment of these injuries. The hallmark of treatment includes rigid skeletal fixation, revascularization, and treatment of soft tissues including appropriate wound coverage techniques.     

Gunshot wounds to the buttocks

Twenty patients sustaining gunshot wounds (GSW) to the buttocks (including one shotgun wound) were treated at two affiliated institutions during the last 5 years. Male patients predominated nine to one. Fifteen patients with extraperitoneal injuries had a benign course. One underwent negative exploratory laparotomy based upon positive physical findings. The remaining five patients had clinical abdominal findings consistent with severe intra-abdominal injuries (four organs per patient). Although the morbidity was high, there was no mortality in this series. Careful analysis of a bullet's trajectory will allow detection of a possible intraabdominal component of this type of injury, mandating early surgical management.