High-velocity facial gunshot wounds: multidisciplinary care from prehospital to discharge

• Published in: BMJ case reports Vol. 2016; p. bcr2015213268
• Main Authors: Sinnott, J D, Morris, G, Medland, P J, Porter, K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 28.01.2016; BMJ Publishing Group
• Series: Case Report
• Subjects: Facial Injuries - surgery; Firearms; Fistula; Humans; Male; Middle Aged; Ostomy; Plastic surgery; Rare Disease; Reconstructive Surgical Procedures - methods; Resuscitation - methods; Skin & tissue grafts; Soft Tissue Injuries - surgery; Suicide, Attempted; Suicides & suicide attempts; Theater; Tracheotomy; Trauma; United Kingdom; Velocity; White; Wounds, Gunshot - surgery; United Kingdom > UK
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2015-213268

A case is presented in which a high velocity rifle (shotgun) was fired into the inferior part of a patient's face in an attempted suicide causing widespread trauma to the inferior and left side of the patient's face. He presented to his general practitioner where an ambulance was called. The patient is followed from prehospital care (air ambulance) to resuscitation in accident and emergency and through the first stages of reconstructive surgery. The article focuses on the multidisciplinary approach to the patient's prehospital care and initial resuscitation at a major trauma centre. CT reconstruction images of the patient's skull allow visualisation of the extent of bone damage at presentation. Medical photography allows visualisation of the extent of the initial damage and shows how reconstructive surgery was undertaken early and in progressive stages. A literature review was performed allowing discussion of the current evidence and best practice in the management of facial gunshot wounds.