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Management of uncomplicated soft tissue gunshot wounds
  1. Kevin Mackway-Jones,
  2. Magnus Harrison
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Kevin Mackway-Jones, Consultant Search checked by Magnus Harrison, Research Fellow

    Clinical scenario

    A 24 year old man is brought to the emergency department by his friends having been shot in the leg. Examination of the thigh reveals a through and through wound with no bone, nerve or major vessel involvement. You wonder whether simple entry and exit wound cleaning with or without antibiotics or surgical debridement is the best treatment.

    Three part question

    In [a young adult with an uncomplicated gunshot to soft tissue only] is [entry and exit wound care better than formal surgical debridement] in [preventing wound infection]?

    Search strategy

    Medline 1966–03/00 using the OVID interface. [({exp firearms OR gun$.mp} AND {exp wounds and injuries OR wound$.mp}) OR exp wounds, gunshot OR gunshot$.mp] AND {exp irrigation OR lavage.mp OR exp debridement OR debridement.mp OR debride$.mp} AND {exp antibiotics OR antibiotic$.mp}] LIMIT to human AND english.

    Search outcome

    Altogether 77 papers found of which 75 were irrelevant or of insufficient quality for inclusion. The two remaining papers are shown in table 4.

    Table 4

    Comment

    There are no randomised trials in this area. The largest study has identified complicating factors but does not directly answer the question posed.

    Clinical bottom line

    Simple soft tissue gunshot wounds without complicating factors can be managed with minimum wound debridement and antibiotics.

    Report by Kevin Mackway-Jones, Consultant Search checked by Magnus Harrison, Research Fellow

    References

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