TS07 RETAINED WEAPONS IN TRAUMA – NON MISSILE PENETRATING INJURIES

Purpose:   Introduction:   Retained weapons present challenges to trauma surgeons. This retrospective review documents our experience with these injuries in Pietermaritzburg over an 18 month period. Methods:   A prospective trauma database is maintained by the general surgical service of the Pietermaritzburg metropolitan hospitals complex. All patients who presented with a retained weapon, non‐missile penetrating injury (NMPI) between July 2007 and November 2008 were identified and reviewed. Results:   We identified 22 patients who had presented with a retained weapon. Twenty‐one were male. The age range was 15–62 years, however 20 cases were <33 years of age. The location of the retained weapon was skull (6), face (6), neck (3), chest and back (6), leg (1). The investigations done included plain X‐rays on 21 cases, CT scan angiography (17) and formal angiography (2). Intercostal drains were required in 5 patients for pneumothoraces (1 bilateral). Twenty weapons were removed in operating room, 1 was accidentally dislodged and 1 was extracted on the ward in view of low Glasgow Coma Scale (GCS) score. Four patients required enucleation to remove a disrupted eye and 1 of these also repair of transected carotid artery. One required vascular repair of popliteal artery. One man improved his GCS score post knife removal. One patient remained paraplegic post knife removal, 1 had left arm paralysis, 1 hemiplegia. There were 2 unavoidable deaths. Conclusion:   Retained weapons must be investigated prior to removal in the haemodynamically compensated patient. They are potentially morbid injuries. The weapon should be removed under controlled conditions by the appropriate surgical service. Residual morbidity relates to the site of the weapon.