Raised Creatine Kinase as an Indicator of Inadequate Muscle Debridement in Ballistic Injuries

A male civilian in his forties presented with multiple thoraco-abdominal gunshot wounds (GSW). After resuscitation and surgical repair of intra-abdominal injuries and debridement of wounds, he improved initially and was extubated successfully. However, his creatine kinase (CK) continued to rise post-operatively and this, together with the development of pyrexia on the fifth post-operative day, led to re-exploration of his wounds. At operation he was found to have large areas of dead muscle within the abdominal and chest walls which required extensive resection. In our view the continued rise in CK was a sensitive marker for ongoing muscle death and is useful in this kind of war surgery.