Preoperative Diagnosis: Multiple gunshot wounds with foreign bodies in the back and neck area.
Postoperative Diagnosis: Multiple gunshot wounds with foreign bodies in the back and neck area.
Operation:
1. Debridement of gunshot wound of the left deltoid
2. Removal of foreign body from the posterior neck
3. Removal of foreign body from the left upper back-parascapular – medial border of the scapula
Anesthesia: General
Complications: None
Blood Loss: Minimal
Drains: N/A
Indications:
This well-developed, well-nourished 19-year-old female was shot this evening in a drive-by shooting. According to police she was mistaken for a gang member. She was brought by ambulance to the emergency room where she was stabilized, then brought to the operating room for surgery to access and repair the damage and to remove the bullets or bullet fragments. A police officer was present throughout the surgery to gather evidence and for chain of custody.
Informed Consent:
The risks and benefits of the procedure were explained to the parent. The parent elected to proceed with the procedures.
Approach and Surgical Procedure:
The patient was placed supine on the operating table, and general anesthesia was induced. The patient was then placed in the right lateral decubitus position with the left side up. The patient was secured in position using beanbags. After that, cushions were applied to the axillary area and to the area beneath the knees and ankles. Next, the posterior neck, deltoid, and back were prepped and draped in the usual sterile fashion. Starting with the left deltoid gunshot wound, an elliptical incision was made around the wound, and devitalized tissue was debrided. The wound was extended to explore the wound and to determine if any foreign bodies were present. The subcutaneous cavity was also debrided, and hemostasis was achieved using electrocautery and clamps.
After achieving hemostasis, the cavity was packed with Betadine dressings, then sterile dressings were applied over the wound. Next, the patient was rotated to expose the upper neck and scapula area.
A transverse incision was made over the palpable foreign body in the upper-neck area. Using blunt and sharp dissection, this foreign body was removed from deep in the muscle tissue. It looked like a solid bullet with slight deformity. The bullet was brass colored and ovoid in configuration. After removing the bullet, the cavity was irrigated and hemostasis was achieved using electrocautery and clamp. Layered closure of the defect was accomplished and the skin was stapled closed. Then, using blunt and sharp dissection, access to a palpable mass in the parascapular soft tissue was obtained, and subsequently the mass was removed. This was another bullet apparently of the same color and shape as the previously mentioned foreign body. After removing the bullet, the cavity was irrigated, hemostasis was achieved, and the wound was closed with layered suture.
The skin was stapled closed, then sterile dressings were applied over the wound. At this point the procedures were completed, and the patient was transferred to the recovery room in stable condition having tolerated the procedures well.
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