Creative Speculation

Date: 11-22-63
Pre-Operative Diagnosis: Gunshot Wound, Right Chest, Right Wrist, Left Thigh
Post-Operative Diagnosis: Same
Operation: Exploration and Debridement of Gunshot Wound of Left Thigh. This portion of the operation is involved only with the operation on the left thigh. The chest injury has been dictated by Dr. Shaw, the orthopedic injury to the arm by Dr. Gregory.
Began: 16:00 Ended: 16:20
Anesthetic: General Began: 13:00
Anesthesiologist: Giesecke
Surgeon: Dr. Shires

Assistants: Drs. McClelland, Baxter, and Patmen
Scrub Nurse: Oliver
Circ. Nurse: Deming and Schroeder
Sponge Counts: 1st Correct, PS

Notes:
There was a 1 cm. punctate missile wound over the juncture of the middle and lower third, medial aspect, of the left thigh. X-rays of the thigh and leg revealed a bullet fragment which was imbedded in the body of the femur in the distal third. The leg was prepared with Phisohex and I. O. Prep and was draped in the usual fashion.

Following this the missile wound was excised and the bullet tract was explored. The missile wound was seen to course through the subcutaneous fat and into the vastus medialis. The necrotic fat and muscle were debrided down to the region of the femur. The direction of the missile wound was judged not to be in the course of the femoral vessal, since the wound was distal and anterior to Hunter's canal. Following complete debridement of the wound and irrigation with saline, the wound was felt to be adequately debrided enough so that three simple through-and through, stainless steel Aloe #28 wire sutures were used encompassing skin, subcutaneous tissue, and muscle fascia on both sides. Following this a sterile dressing was applied. The dorsalis pedis and posterior tibial pulses in both legs were quite good. The thoracic procedure had been completed at this time, the debridement of the compound fracture in the arm was still in progress at the time this soft tissue injury repair was completed.