Death from accidental shotgun discharges is fortunately uncommon in England and Wales but injuries from firearms are still observed in civilians.

Not only do such injuries cause immediate tissue damage but injury to the surrounding structures from the force of the blast can challenge the surgeons’ attempts to reconstruct.

Ideally, if conditions prevail, free tissue transfer reconstruction is the preferred method of reconstruction nowadays. In some circumstances the use of established and older techniques are the only option.

This report describes the case of thumb reconstruction using pedicled groin flap; a technique described in early 1970s and was widely used for many years.

The video here shows the devastation to a man’s left non-dominant thumb after he inadvertently fired a 20-bore cartridge with 12 bore shotgun which lodged at the waist of the barrel. He then reloaded with a 12 bore cartridge. On firing the gun barrel exploded causing extensive degloving and blast injury to his left thumb.

Vascular injury was extensive and precluded immediate microvascular repair or reconstruction and so therefore his thumb was reconstructed using a pedicled groin flap.

Inherent in this technique is the requirement for the hand to be placed in a dependent position to three weeks or so until the flap could be sustained from regrowth of arteries and veins from the thumb itself.

Further sequences of operations are required in order to obtain a functionally useful hand. The whole process for this gentleman took a year!

My patient was able to return to his dental practice and continues to enjoy his hobby of shooting.

When last reviewed he had just attended a practical dental update course and informed me but he scored top of the group – a testament to his tenacity!

WARNING: The video shows graphic images of the injury and surgery