Self-Inflicted Gunshot Wound to the Hand in Partner Forces – Part 2


Intra operative

  • Incise and drain entrance and exit wounds
  • Open carpal tunnel release
  • Intact median nerve
  • Intact extensor tendons, < 50% damage to flexor digitorum superficialis and flexor digitorum profundus
  • Intact deep and superficial palmar arch
  • Comminuted third metacarpal and capitate fracture, non-displaced fourth metacarpal base fracture
  • Surgical incisions closed loosely, entrance/exit wounds left open

 Post operative

fig 3

If you could not guarantee continuity of care (must pass care to a lower standard), what instructions would you give to the accepting physician and the patient?

Are there any cultural/military discipline implications for this injury?

Self-Inflicted Gun Shot Wound to the Hand in Partner Forces – Part 1



  • 26-year-old right hand dominant male Afghan, member of the Afghan Local Police (ALP).
  • Self-inflicted gun shot wound to left hand, presented for treatment within 8 hours to the Forward Operating Base surgical team.
  • Decreased sensation median nerve distribution, intact radial and ulnar nerve sensation.
  • Brisk capillary refill was less than 2 seconds inall digits (perfusion adequate). 
  • Motor exam not possible due to pain.

Pre operative

fig 1

fig 2

Operation proceeded within an hour after presentation. 

In the austere environment, what should be done for this patient?

What are the goals of surgery?