We report two cases involving small-caliber gunshot wounds to the chest with embolization of the bullet which complete occluding arterial circulation into the left lower extremity. A 30-years-old and 19-years-old men suffered gunshots wound to the thorax and abdomen with subsequent arterial embolisms into their left legs. Image studies revealed the left popliteal and femoral arteries occlusion by the missiles. Arteriotomies were auspiciously performed to retrieve the projectiles along with Fogarty catheters thrombectomies which conclude successful outcomes. At a 6 and 36 months’,follow-up, the patients were doing well without any vascular associated complications. Bullet embolization of the arterial or venous systems is a rare complication of penetrating gunshot injuries with diagnostic and therapeutic challenges. This complication’, s suspicion should rise when there is a gunshot injury without an exit wound and with sudden pain or ischemia in an extremity. Individualized treatment should be urgently performed to avoid irreversible damage to the affected area.

Background: The incidence of firearm related non-fatal and fatal accidents has been increased worldwide. Most of the unintentional or intentional nonfatal gunshot injuries involve an extremity.Case Report: A 33-year-old man was admitted to emergency department with a complaint of injury related to 5th metacarpal area of right hand. The patient reported that he is a police officer who suffered gunshot injury during crashes with smugglers in himself right hand. At arriving time into hospital, hand was neurologically intact and no vascular injury was noted. There was a distractive entrance wound in the 5th metacarpal hypothenar palmar area and a distractive exit wound on the dorsal side. The wound was irrigated and debrided. All lose bone fragments were removed. The lose area covered by distant flap of skin from the abdomen. All of the wounds were healed on postoperative 15th day.Conclusion: This report is an attempt to present the problem of firearm injury and appeal to a wide range of disciplines working to expand their knowledge and redirect new energy to address the urgent problem of firearm injury.

Introduction: The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned. Case Presentation: Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects. Conclusions: The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss.

Background: Gunshot wound injuries to penile are relatively infrequent. Objectives: This study aimed at reviewing the patterns of gunshot injuries to the penile and their treatments. Methods: In November 2019, PubMed (MEDLINE), Scopus, Embase, ISI web of sciences and Google Scholar databases were searched for finding relevant studies. For this reason, various meshes and keywords were used to search including wound/injury, genitalia/genitourinary, Gunshot/war/explosion/firearm/military, penile/penis, scrotum, and urethral. Results: Of the five included studies, three studies were related to civilian gunshot injuries and two studies were related to war-injury. The average age of patients was in the range of 28-31 years old. The major gunshot penile injuries were Corporotomy, Corpus cavernosum, superficial penile wounds, and urethral injury. The most frequent concomitant damages were injuries to adjacent anatomies, including thigh injury, scrotal/testicular, abdominal organs, bladder, and rectum. There are several surgical procedures depending on the degree of gunshot penile injuries such as surgical exploration, closing the residual penile stump of a partly amputated penis, penile degloving, penoscrotal approach, simple suturing, hemostatic suturing of Buck’ s fascia and skin, and surgical re-anastomosis or total replacement with phallic reconstruction. Conclusion: Penile gunshot injuries often are concomitant with other severe injuries in adjacent anatomies, which have a negative impact on the mortality of victims. For the management of these cases, it is essential to evaluate the length and size of and type of weapons.

Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of craniocerebral penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the affected individual, the family and the health system in providing ongoing care to the sufferers and society at large. Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to provide positive impact on improvement of the quality of life and further providing better care and reduction of overall health care cost.

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