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<< Ballistic Injuries In The Emergency Department (Trauma CME)

Management Of Soft Tissue Injuries

Soft tissue wounds are often managed in the ED, either by the emergency clinician or a consultant. High-velocity and shotgun wounds are the exception, as they often need meticulous debridement and frequently require second-look procedures. Smaller, isolated wounds to skin, subcutaneous tissue, and muscle are very amenable to simple irrigation and debridement. A large retrospective review by Ordog et al examined outcomes of gunshot wound patients managed with simple wound debridement, antibiotic ointment, and oral antibiotics. They found only a 1.8% incidence of wound infections, and 60% of the patients in this study were managed as outpatients.127 A small, retrospective observational study by Byrne and Curran examined the rate of successful ED management of isolated gunshot wounds to the lower extremity. They found a significantly low rate of complications compared to inpatient management, as well as significant savings in terms of total inpatient hospital days.109

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