Lower Extremity Shotgun Wound

A 32-year-old white man presented to the emergency department after suffering a shotgun wound to the left lower extremity. He reports assault at point-blank range with a gun of unknown gauge while lying in the prone position. He was transported to the emergency department by emergency medical services personnel who started the use of peripherally inserted intravenous catheters and applied pressure to slow the bleeding. Physical examination reveals a young, healthy appearing male in no apparent distress. Mangled gastrocnemius was clearly visible. The wound was not actively bleeding. Distal pulses (dorsalis pedis and posterior tibialis) were 2+ and the toes had good capillary refill less than 2 seconds. Motor and sensation were grossly intact.