Management of Maxillofacial Gunshot Trauma in the Stomatology and Maxillofacial Surgery Departments of Ouagadougou

Introduction: Maxillofacial ballistic trauma is a serious injury that is difficult to manage, with significant complications and after-effects. The authors report their experience in managing this type of trauma in the context of insecurity linked to terrorism. Patients and Methods: This was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2018 to December 31, 2022 in the stomatology and maxillofacial surgery departments of the university hospitals of Ouagadougou. Results: In 5 years, 52 patients were collected, i.e. 10.4 cases per year. The mean age of the patients was 31.46 ± 15.41 years, and the sex ratio was 3. In 67.31% of patients, these injuries were the result of shootings during terrorist attacks. The jugal (36.54%) and chin (32.69%) regions were the most affected. The mandible (36.54%) and zygomatic bones (28.85%) were the most injured bones in these traumas. All patients underwent surgical treatment, and 25% suffered secondary complications. All patients retained at least one sequela. Conclusion: Maxillofacial injuries caused by ballistic trauma are true emergencies that can be life-threatening and functionally disabling. Their management is delicate and the outcome is uncertain, hence, the prevention is important.

Combination of dura turning-over and decompressive craniectomy： a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury

Background:Craniocerebral gunshot injury refers to a wound caused by a bullet passing through or lodged in brain tissue,resulting in the loss of function of a certain area or other fatal damage to the human brain.Craniocerebral gunshot injury is usually life-threatening and is very common in modern warfare,accounting for the majority of battle casualties.Most of the patients suffer from acute cerebral infarction caused by vascular injury.Lack of early and solid battlefield emergency medical interference adds to the risk of death among the wounded.Case presentation:We present a 24-year-old man who was shot with a shotgun from a distance of 15m in an accidental injury.Forty-seven grape shots were found on his body surface by physical examination.A computed tomography(CT)scan demonstrated large areas of low-density shadows in his right parietal lobe and right temporal lobe with the midline shifting to the left side 2 days later.Afterwards,the patient was transferred to our emergency medical center at Changzheng Hospital in Shanghai.Cranial computed tomography angiography(CTA)showed a high-density shadow in the initial part of the right middle cerebral artery.The branches after the initial part were obliterated.Prompt medical attention and decompressive craniotomy(DC)surgery contributed to the final recovery from cerebral infarction of this patient.Conclusion:Bullets can penetrate or be lodged in the brain,causing intracranial hypertension.The bullets lodged in the brain can result in stenosis and embolism of a cerebral artery,causing acute cerebral infarction.Combining dura turning-over surgery with DC surgery can not only decrease intracranial pressure,which can increase the blood supply for hypertension-induced vessel stenosis,but also help vessels outside the dura mater grow into ischemic areas of the cerebral cortex.However,this new pattern of surgery needs further support from evidence-based medicine.

Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.

Gunshot Wound to the Head: Surgical Management and Cases Report in a Tertiary Care Center in Florencia, Colombia

The purpose of this research is to report 10 cases treated in a tertiary care center in the Florencia town in Colombia. The time frame to this intervention was from 1st June 2011 to 30th June 2012. The idea was to establish the type, age group, Matson’s classification schemes and mortality of the gunshot wound to the head in order to describe the neurological functional prognosis of these patients, made by The Modified Rankin scale (mRS) to 12 months postoperative.

OnabotulinumtoxinA in the Treatment of Occipital Neuralgia Following Gunshot Injury

Occipital neuralgia, while typically idiopathic in presentation, is a common form of posttraumatic headache. It is associated with severe pain in the greater, lesser, and/or third occipital nerves, and often accompanied by tenderness or trigger points in the surrounding musculature. OnabotulinumtoxinA (ONA) has been recently utilized in nerve blocks to treat occipital neuralgia, but current literature supporting such use is scarce. We describe a case of occipital neuralgia in a patient following C1 fracture and vertebral artery dissection due to gunshot injury. Successful treatment with bilateral ONA nerve blocks led to an 80% - 90% improvement in pain, with decreased Visual Analog Scale (VAS) pain scores immediately following treatment and upon follow-up 1 month later.

Internal Fixation of Gunshot Induced Fractures in Civilians: Anatomic and Functional Results of a Standard Protocol at an Urban Trauma Center

Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion: In civilian’s gunshot induced fractures, internal fixation can be made according to standard protocol, with acceptable result.

Simultaneous, Asymmetrical, Comminuted and Bilateral Ballistic Fractures by Multiple Gunshot Wounds and a Review of Its Literature: A Case Report in Chad

Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.

Impact-disrupted gunshot residue：A sub-micron analysis using a novel collection protocol

The analysis of gunshot residue(GSR) has played an integral role within the legal system in relation to shooting cases. With a characteristic elemental composition of lead, antimony, barium, and a typically discriminative spheroidal morphology, the presence and distribution of GSR can aid in firearm investigations. In this experiment, three shots of low velocity rim-fire ammunition were fired over polished silicon collection substrates placed at six intervals over a 100 cm range. The samples were analysed using a Field Emission Gun Scanning Electron Microscope(FEG-SEM) in conjunction with an X-flash Energy Dispersive X-ray(EDX) detector, allowing for GSR particle analyses of composition and structure at the sub-micron level. The results of this experiment indicate that although classic spheroidal particles are present consistently throughout the entire range of samples their sizes vary significantly, and at certain distances from the firearm particles with an irregular morphology were discerned, forming "impactdisrupted" GSR particles, henceforth colloquially referred to as "splats". Upon further analysis, trends with regards to the formation of these splat particles were distinguished. An increase in splat frequency was observed starting at 10 cm from the firearm, with 147 mm^(-2) splat density, reaching a maximal flux at 40 cm(451 mm^(-2)), followed by a gradual decrease to the maximum range sampled. Moreover, the structural morphology of the splats changes throughout the sampling range. At the distances closest to the firearm, molten-looking particles were formed, demonstrating the metallic residues were in a liquid state when their flight path was disrupted. However, at increased distances-primarily where the discharge plume was at maximum dispersion and moving away from the firearm, the residues have had time to cool in-fight resulting in semi-congealed and solid particles that subsequently disrupted upon impact, forming more structured as well as disaggregated splats. The relative compositions of the characteristic elements that are present in GSR also change in the different splat morphologies sampled,which may contribute to the particles' physical structures. Two distinct populations of splats were also observed: circular and elongated, which suggest the residues hit the substrate at different angles. The difference in the splat impact angle can be ascribed to the position of the residues within the firearm discharge plume; particles get caught up in the vortex that is created by the discharge gases behind the projectile as it leaves the barrel, thereby affecting their directionality and flight time. This reasoning could also justify the existence of both spheroidal and splat particles at certain distances. The novel sampling and analytical techniques used in this experiment have provided previously unknown information in relation to GSR structure and formation which could have greater implications to its current analysis amongst laboratories and law enforcement agencies worldwide.

损害控制手术治疗高原寒冷环境猪腹部枪击肠管贯通伤的效果评价

目的观察损害控制手术(DCS)与传统手术对于高原寒冷环境下猪腹部枪击肠管贯通伤的救治效果。方法本文前瞻性研究,将30头10~12周龄健康长白仔猪,随机分为3组(各10只),分别为高原致伤组(HI)、高原致伤+传统手术组(HIT)、高原致伤+DCS组(HID)。通过将仔猪放入模拟高原寒冷环境的西北地区特殊环境人工实验舱[设置舱内海拔6000 m,气压约4.7 kPa,温度(8±2)℃,模拟高原低压、低氧、寒冷环境]48 h,并使用警用制式QSZ92式手枪,9 mm手枪弹射击脐水平后方2 cm,右侧腹壁皱襞下缘交界处目标点制作高原寒冷环境猪腹部枪击肠管贯通伤模型。HI组受伤后予以伤口包扎后观察处理。HIT组伤后4 h予以断裂小肠或缺血坏死小肠切除后行肠管端端吻合的传统手术治疗。HID组伤后4 h行断裂小肠近端置入减压管,远端小肠封闭;连续多处穿孔小肠或缺血坏死小肠切除,近端置入减压管,远端小肠封闭的DCS治疗。分别观察并比较各组伤后不同时间一般情况、生命体征、手术相关指标,WBC、中性粒细胞计数(NEUT)、IL-6、TNF-α、ALT、AST、并发症发生率、存活率。结果HIT组和HID组的小肠挫伤、小肠破裂、肠系膜损伤、结肠破裂、弹孔直径、腹腔积血无明显差异(P>0.05)。HID组12 h开始呼吸(25.2±4.0)次/min、心率(129.9±9.8)次/min、体温(38.3±0.6)℃显著低于HI组[呼吸(38.7±4.7)次/min、心率(150.3±8.6)次/min、体温(40.2±1.0)℃]和HIT组[呼吸(32.0±4.0)次/min、心率(143.6±11.4)次/min,体温(38.8±0.6)℃];HID组48 h体温低于HIT组[(38.3±0.6)℃vs.(39.6±0.6)℃],差异有统计学意义(P<0.05),生命体征更快达到平稳状态。HID组的手术时间、呼吸恢复时间、拔管时间、自由活动时间和首次排便时间显著短于HIT组[(46.00±9.37)min vs.(146.00±14.68)min、(26.20±4.24)min vs.(46.10±3.84)min、(45.40±3.03)min vs.(95.70±3.30)min、(96.90±4.48)min vs.(198.20±4.80)min、(27.90±7.80)h vs.(47.99±5.41)h];术中失血量及输液量少于HIT组(P<0.05)。HID组12 h开始WBC(18.4±4.8)×10^(9)/L、NEUT(3.3±1.1)×10^(9)/L、IL-6(110.4±8.7)pg/mL、TNF-α(288.5±16.4)×10^(9)/L低于HI组[WBC(56.6±9.3)×10^(9)/L、NEUT(24.0±4.4)×10^(9)/L、IL-6(158.8±16.0)pg/mL、TNF-α(425.4±35.3)pg/mL];HID组WBC和NEUT于12 h起低于HIT组;IL-6于24 h起低于HIT组;TNF-α于48 h起低于HIT组(P<0.05)。HID组12 h开始ALT、AST低于HI组[(88.4±9.9)U/L vs.(138.1±14.4)U/L、(110.4±8.8)U/L vs.(210.1±11.6)U/L];HID组24 h开始ALT、AST低于HIT组[(66.6±14.0)U/L vs.(82.0±8.3)U/L、(96.4±8.9)U/L vs.(10^(9).7±9.9)U/L],P<0.05。HID组术后发热、切口出血、切口皮肤淤斑、肠漏发生率低于HIT组(P<0.05)。HI组、HIT组、HID组72 h存活率分别为60%、70%、100%。HID组生存曲线优于HI组(P<0.05)。结论与传统手术治疗比较,伤后早期行DCS治疗,可缩短手术时间,减少术中出血,加快麻醉苏醒,促进术后早期胃肠道功能恢复及活动,降低手术并发症,改善仔猪生命体征、血清炎症因子水平、生存时间,提示DCS是早期治疗高原寒冷环境腹部枪击肠管贯通伤的有效方法。

基于深度学习的枪声联合识别定位

针对现有枪声识别与定位任务中,识别与定位需分别进行,造成计算耗时、系统冗余、开发流程复杂等问题,提出使用一个Two Stage CRNN深度学习网络模型处理枪声识别与定位任务。首先,对采集到的枪声信号进行对数梅尔变换并计算广义相变互相关谱作为网络模型输入;其次,第一阶段通过CRNN网络对枪声信号进行识别;最后,第二阶段通过引入掩码实现判断是否将CRNN网络权重共享实现定位。相关实验表明,此方法能有效解决传统方法中识别与定位任务分别实现、系统冗余、开发流程复杂的问题,在实现联合识别定位中具有一定的应用价值。

Gunshot injury to spine:An institutional experience of management and complications from a developing country

Purpose Gunshot wounds are the second leading cause of spinal cord injuries.Surgical intervention for gunshot injury to the spine carries a high rate of complications.There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan.Approximately 60 cases over the last 10 years have been recoded,with unusual presentation and neurological recovery.Thus it is imperative to fill this gap in data,by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital(Aga Khan University Hospital,Karachi).Methods This is a retrospective cohort study.Patients of all ages who presented to the emergency department of Aga Khan University Hospital,with gunshot injuries to spine between January 2005 and December 2016 were included in the study.Data were collected on neurological status(American Spinal Injury Association score was used for the initial and follow-up neurological assessment),extent of cord transection,motor and sensory deficits.The patients were further grouped into those with cord transection,and those with fractures of the bony spine but an intact spinal cord.These patients were then followed and the outcomes were recorded.Results A total of 40 patients were identified.The mean±SD of patients age was(30.9±9.5)years.Of the 40 patients with gunshot wounds,31 had the medical imaging performed at the facility,and hence they were included in this categorization.The remaining 9 patients were excluded from this additional grouping.Thirteen patients were managed surgically and 27 patients underwent the conservative management.The mean±SD of follow-up was(8.7±7.2)months.In our study,the thoracic spine was the most commonly injured region in gunshot injuries.Of the 31 patients with medical imaging performed at our institute,17(54.8%)had cord transection,of whom 8(47%)ultimately developed paraplegia.Conclusion The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected.This will help healthcare providers to plan the further management of the patient and counsel them accordingly.

Transcranial lateral perforating gunshot injury through skull base presenting without residual damage:A fortunate survivor

We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault.The bullet entered above the right zygomatic arch,travelling through the coronal plane,and exited from the left zygomatic arch.The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay.Non-contrast CT scan of the head revealed fractures of the right orbit,bilateral maxilla,bilateral pterygoid plates,ethmoid air cells,vomer and left zygoma,and without any cerebral damage.He was treated conservatively and the facial palsy was resolved.The patient survived without any complications.Such case has not been described in the available literature till date.

Terrorist attacks:cutaneous patterns of gunshot and secondary blast injuries

Terrorist attacks have been on the rise.During the recent terrorist attacks in France,terrorists perpetrated their acts using weapons of war,as well as explosive charges.These two modes of action,when combined,can create skin lesions with similar macroscopic appearances,which can sometimes go unnoticed because of body fragmentation.A total of 68 autopsies,83 external examinations,140 standard radiographic examinations,and 49 computed tomography(CT)scans were performed over 7 days during the 2015 terrorist attacks in France.Bodies were injured by firearms and shrapnel-like projectiles.We analysed the clinical findings for the secondary blast cutaneous lesions from the explosive devices and compared these lesions with ballistic-related lesions to highlight that patterns can be macroscopically similar on external examination.Secondary blast injuries are characterised by penetrating trauma associated with materials added to explosive systems that are propelled by explosive air movement.These injuries are caused most often by small,shrapnel-like metallic objects,such as nails and bolts.Propulsion causes ballistic-type injuries that must be recognised and distinguished from those caused by firearm projectiles.Differentiating between these lesions is very difficult when using conventional criteria(size,shape,number and distribution on the body)with only external examination of corpses.This is why the particularities of these lesions must be further illustrated and then confirmed by complete autopsies and radiological and anatomopathological examinations.

Civilian gunshot wounds to the head:a case report,clinical management,and literature review

Background:Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion.Gunshot wounds to the head are the deadliest of all gun injuries.According to literature statistics,the survival rate of patients with gunshot wounds to the head is only 9%.Due to the strict management of various types of firearms,they rarely occur,so the injury mechanism,injury and trauma analysis,clinical management,and surgical standards are almost entirely based on military experience,and there are few related reports,especially of the head,in which an individual suffered a fatal blow more than once in a short time.We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case presentations:We present a case of a 53-year-old man who suffered two gunshot injuries to the head under unknown circumstances.On initial presentation,the patient had a Glasgow Coma Scale score of 6,was unable to communicate,and had loss of consciousness.The first bullet penetrated the right frontal area and finally reached the right occipital lobe.When the patient reflexively shielded his head with his hand,the second bullet passed through the patient’s right palm bone,entered the right frontotemporal area,and came to rest deep in the lateral sulcus.The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan.After two foreign body removals and skull repair,the patient recovered completely.Conclusions:Gunshot wounds to the head have a high mortality rate and usually require aggressive management.Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital,followed by proactive treatment against infection,seizure,and increased intracranial pressure.Surgical intervention is usually necessary,and its key points include the timing,method,and scope of the operation.

Trends in Gunshot Residue Detection by Electrochemical Methods for Forensic Purpose

Gunshot Residue(GSR)has been a subject of interest for the forensic fraternity.Numerous analytical contributions towards the GSR analysis have been reported.Sensitivity,portability,cost-effectiveness,speed,etc.are such factors of electrochemical methods that have attracted the researchers across the globe to test the applicability of these as a potential analytical tool for forensic evaluation of GSR.With the development of scientific technology,efforts have been made towards the handheld device for the on-field analysis of GSR.Recently,chemometric treatment of data generated from the electrochemical analysis of GSR has offered more effective approach.It makes the analysis more conclusive and minimizes the chances of false-positive detection.It will be very fruitful to anticipate the analytical potential of electrochemical tools for GSR analysis.This article reviews the research progress towards the development of electrochemical sensor for GSR detection reported during 2013-2020 along with challenges and future perspectives.

Determination of Diphenylamine in Gunshot Residue by HPLC‑MS/MS

A high performance liquid chromatography tandem mass spectrometry/mass spectrometry(HPLC-MS/MS)protocol was developed for the determination of diphenylamine(DPA).Four productions of DPA were selected for qualitative assay and the peak area of the main product ion for quantitation.By means of separation using an Agilent Extend-C18 column(CA,USA)(150 mm×4.6 mm,5μm)with methanol‑water(90:10)as the mobile phase,DPA was detected by electrospray ionization(ESI)tandem mass spectrometry in positive mode.The linearity of the peak area versus concentration ranged 5‑500 ng/mL,r^(2)=0.9978.The limit of detection(S/N=3)of this method was 0.3 ng/mL.This method is applicable for the determination of DPA in gunshot residue.

Evaluation of follow-up and long-term outcomes of gunshot and stab wounds in a French civilian population

Purpose The data concerning long-term follow-up and outcomes of penetrating trauma are poorly detailed in the literature.The main objective of our study was to analyze the hospital and extra-hospital follow-up of penetrating trauma victims and to evaluate the late complications and long-term consequences of these traumas.Methods This work was a retrospective longitudinal monocentric observational study conducted at Laveran Military Hospital,from January 2007 to January 2017.All patients hospitalized for gunshot wound or stab wound management during this period were identified via a retrospective systematic query in the hospital information system using the ICD-10 codes.Epidemiological data,traumatism characteristics,hospital management,follow-up and traumatism consequences(i.e.,persistent disability)were analyzed.To improve evaluation of traumatism long-term consequences,extra-hospital follow-up data from general physicians(GP)were collected by phone call.During this interview,9 closed questions were asked to the GP.The survey evaluated:the date of the last consultation related to injury with the GP,the specific follow-up carried out by the GP,traumatism consequences,and recurrence of traumatism.Descriptive,univariate and multivariate with regression analysis were used for statistical analysis.Results A total number of 165 patients were included.Median(Q1,Q3)of hospital follow-up was 28(4,66)days.One hundred one patients(61.2%)went to their one-month consultation at hospital.GP follow-up was achieved for 76 patients(55.2%).Median(Q1,Q3)of GP follow-up was 47(21,75)months.Twenty-four patients(14.5%)have been totally lost to follow up.The overall follow-up identified 54 patients(32.7%)with long-term consequences,20 being psychiatric disorders and 30 organic injuries.Organic consequences were mainly peripheral nerve damages(n=20;12.1%).Most of the psychiatric consequences were diagnosed during GP follow-up(n=14;70%).Seventeen cases(10.3%)of recurrence were found and late mortality occurred in 4 patients(2.4%).High injury severity score,older age and gunshot wound were significantly linked to long-term consequences.Data collection and analysis were carried out in accordance with MR004 reference methodology.Conclusion This study showed a high rate of long-term consequences among patients managed for penetrating injury.If all organic lesions are diagnosed during hospital follow-up and jointly managed by hospital and extra-hospital physicians,most socio-psychiatric consequences were detected and followed by extra-hospital workers.However,for half of the patients,the extra-hospital follow-up could not be assessed.Thus,these consequences are very probably underestimated.It appears imperative to strengthen the compliance and adherence of these patients to the care network.Awareness and involvement of medical,paramedical teams and GP role seems essential to screen and manage these consequences.

Adrenal gland injury due to gunshot

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient’s morbidity or mortality.

Surgical treatment for rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

Objective: To investigate the surgical treatment methods and evaluate the outcome of gunshot wounds combining with seawater immersion in rabbits’ femoral arteries. Methods: One hundred healthy New Zealand white rabbits (either sex, 3.14 kg± 0.61 kg in weight) were randomly divided into a seawater immersion group (n=50) and a simple injury group (n=50). The unilateral femoral arteries of all the rabbits were injured by 0.38 g steel spheres with velocity of 600-800 m/s fired by a 7.62 mm rifle. The rabbits in the seawater immersion group were immersed in seawater (saline content of 2.54%, pH 8.2- 8.4, and at 21℃) for 60 minutes but those in the simple injury group were not. After the injured segment (observed by naked eyes) of the femoral artery was excised, the blood flow restoration was reconstructed by direct end-to-end anastomosis, reversed autogenous venous grafting or cryopreserved arterial allografting, according to the length of the arterial defects. At 24 hours, and 7, 14 and 21 days after operation, the blood flow was examined. Operative exploration was performed for the animals with partly or fully obstructed blood flow. The tissues around the anastomosis sites and the grafts were harvested for pathological observation under a light microscope and an electron microscope. Results: In the rabbits with completely transected injury, the unobstructed rates in the first 3 weeks after operation were 80.00% in the seawater immersion group and 86.67% in the single injury group, and no significant difference was found between the two groups (P> 0.1). In the rabbits with arterial contusion injury, the unobstructed rates in the first 3 weeks after operation were 86.67% in the seawater immersion group and 82.35% in the single injury group, and no significant difference was found between the two groups (P> 0.1). Most thrombosis occurred in the first operative week. Atypical endothelial cells were detected at the anastomosis sites at the first operative week, and the anastomosis sites were lined with endothelial cells in 3 weeks postoperatively. Conclusions: During the surgical treatment for gunshot wounds combining with seawater immersion, resection of the grossly-injured artery and routine artery reconstruction can obtain satisfactory outcome. Homologous artery is a kind of vascular graft with certain applied value.

Pathological study of rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

Objective: To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group I, n=10), gunshot wound with seawater immersion for 30 mins (Group II, n=10), and 60 mins group (Group III, n=10). Femoral arteries were impacted by (0.38 g) steel spheres fired with a (7.62 mm) rifle. After being wounded, rabbits in Groups II and III were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy. Results: The patterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group I, the primary-wound-tract and contused areas in Group II manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group II and III. The pathological changes in the shocked area were similar in 3 groups. Conclusions: For gunshot wounds concomitant seawater immersion in rabbits’ femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.