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Fig. 4A —19-year-old woman with multiple shrapnel wounds. Patient
suffered extensive tissue damage from multiple shrapnel fragments. With
multiple shrapnel wounds, dilemma for clinicians is whether to perform
débridment and further imaging. In most cases, surgery is not indicated
because metals often remain inert and do not cause damage. Indications for
removal are proximity to neurovascular structures, intraarticular involvement,
or possibility of toxic effects of metal such as lead. Late indications
include infections.
