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Self-Inflicted GSWs to the Hand, a Review
Brian W. Starr, MD, Doug R. Dembinski, MD, Elizabeth A. Lax, MD, Suma Yalamanchili, MD, David M. Megee, MD
University of Cincinnati
2019-02-13
Presenter: Brian W Starr
Affidavit:
All authors have made substantial contributions defined by the conception and design of the study, acquisition of data, analysis and interpretation of data, and/ or drafting or revising the the abstract/ manuscript critically for important intellectual content, and final approval of the version being submitted.
Director Name: Ann Schwentker, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction: To the best of our knowledge, no study exists specifically examining self-inflicted gunshot wounds (GSWs) involving the upper extremity. These "point-blank" injuries impart greater energy than comparable low-velocity GSWs, and, we hypothesize that they are associated with greater morbidity.
Methods: A retrospective review was performed, examining records of patients who presented to our plastic surgery service after sustaining acute gunshot wounds involving the upper extremity between 2016 and 2018.
Results: We identified 60 patients who sustained GSWs involving the hand, wrist and forearm presenting to our level 1 trauma center plastic surgery service between 2016 and 2018. Seventeen (28%) self-inflicted GSWs and 43 (72%) non-self-inflicted GSWs were identified. Within the self-inflicted group, 57% of operative injuries required more than one operation compared to only 12.5% within the non-self-inflicted group (p=0.02). Patients who sustained self-inflicted injuries were more likely to present with acute carpal tunnel syndrome requiring urgent surgical release (12% vs 0%, p=0.02). Patients who underwent operative intervention following self-inflicted GSWs were also more likely to develop post-operative wound infections (29% vs 0%, p=0.02).
Conclusion: Self-inflicted GSWs involving the hand, wrist and forearm are associated with greater morbidity than their lower-energy non-self-inflicted counterparts. Compared with traditional GSW patients, individuals presenting with self-inflicted GSWs are more likely to be older patients, are more likely to require multiple operations – with a higher risk of post-op infection – and are more likely to present with acute carpal tunnel syndrome requiring urgent surgical decompression.
