Blessures des membres et du rachis par projectiles

Abstract

Gunshot wounds include multi-tissular and heterogeneous lesions. Responsible agents are various: firearms, attack guns, hunting rifles, mines and terrorist machines. The management of patients with such wounds is no longer the matter of the sole military practitioners; since the emergence of terrorism and crime in the cities, the civil community is more and more often concerned. Such lesions have to be managed according to specific rules of which doctors should be aware because sometimes they differ from usual traumatology. Dressing is the main step in the surgical management. It allows fighting efficiently the omnipresent infection. Vascular lesions are frequent and necessitate sometimes urgent revascularization. Except in particular cases, bone stabilization is performed using external fixation. Cutaneous suture is delayed. Most of the time, recovery induces reiterative dressings and secondary reconstructive surgery. Despite great improvements, sequelae remain important and emergency or secondary amputation is still frequent.