Management of gunshot wounds of the limbs.

The incidence of bullet wounds in civilian trauma has increased in many parts of the world, sometimes approaching epidemic level. For surgeons with limited experience there is a bewildering range of apparently contradictory advice on management. An attempt to clarify this for gunshot injuries of the limbs, without major vascular injury, must include current concepts of ballistic wounding, the pathology of soft-tissue wounds and fractures, and of bacterial contamination. Advice on clinical practice and treatment options cannot be prescriptive because of the wide range of injury patterns and settings, but an understanding of the general principles can guide clinical management.