Analysis of Risk Factors of Wound Infection in Gunshot Injuries with Retained Bullets

Abstract

To establish the pattern and potential of would infection in gunshot injuries with retained bullets, a retrospective survey was undertaken at Chang Gung Memorial Hospital in Kaohsiung. Twenty-six cases, with a combined total of thirty-one gunshot wounds with retained bullets distributed in different sites, were seen between January 1994 and June 2002. The average age was 29 years and 24 patients were male. Shock, peripheral vessel injury, bullet size, bullet fragmentation, and a linger time lag between arrival at the emergency room and surgery to remove the bullet was not associated with an increased of wound infection. Associated extremity comminuted bone fractures in five cases were recognized as a risk factor for wound infection, as four of these cases sustained wound infection; in addition, muscle necrosis inside all of the infected wounds was found in subsequent debridement surgery. High kinetic energy during the impact of high velocity missiles that are stopped by the obstacle of high-density bones is suggested to contribute to tissue special attention in such situations to prevent further wound infection.