Peripheral vascular injuries from plastic bullets in children.

During an eight month interval, 15 children and adolescents less than 20 years of age sustained vascular injuries to the lower extremities from plastic bullets. The plastic bullets had been introduced by the authorities as an attempt to reduce mortality from clashes between soldiers and demonstrators. Twenty-three vessels were injured in these 15 children: four patients had isolated arterial injuries, three had isolated venous injuries, and eight had combined injuries. The arterial injuries were repaired primarily or with reversed saphenous vein interposition grafts. The limb salvage rate was 100 percent, and there were no deaths. Eighty percent of the patients had palpable distal pulses observed at follow-up examination. We conclude from this experience that plastic bullets can cause serious injuries in children, vascular injuries from gunshots in children should be repaired or reconstructed using techniques perfected in the adult population, and low velocity gunshot vascular injuries in the pediatric age group can be successfully treated in a minimally equipped, developing world hospital by well-trained general surgeons.