Gunshots to the hand and upper extremity.

Gunshot injuries to the hand and upper extremity have been studied during military conflicts and in urban settings. Treatment concepts include identification of injured structures, aggressive surgical wound care, and reconstruction of important functional structures. There are various types of missile injuries. For simplicity, low-energy injuries imply limited damage, and require only conservative approaches. High-energy injuries are complicated by significant tissue destruction, rehabilitation dilemmas, and uncertain outcomes. The surgeon must recognize the anatomic complexity of the hand and proceed with caution. Most gunshot injuries to the hand involve a combination of tissue types. Bone injury is dramatic and is seen radiographically. However, injury to the soft tissue including skin, tendon, blood vessel, and nerve also must be appreciated. Individually, the tissues have varied function and properties of healing. Therefore, the challenge is to prioritize the injury, select an aggressive surgical approach, and integrate a suitable rehabilitation plan.