Aim. To develop a comprehensive strategy for the treatment of isolated gunshot shrapnel wounds of soft tissues at various locations.

Materials and methods. This study analyzed outcomes in 5,000 patients of working age (18–49 years) treated for isolated gunshot and shrapnel soft-tissue wounds at hospitals in Zaporizhzhia and the Zaporizhzhia Military Hospital between March 2022 and June 2025. The injuries were predominantly localized in the lower extremities (67.06 %), less frequently in the upper extremities (25.14 %) and trunk (7.78 %). Different treatment approaches were applied: platelet-rich plasma (PRP) in combination with delayed primary sutures (DPS) or early secondary closure (ESC), modified autodermoplasty, and local or free flap reconstructions.

Results. PRP combined with suturing was applied in 3851 cases (77.02 %): DPC in 2394 (47.88 %) and ESC in 1457 (29.14 %). The complication rates were 7.81 % with DPC and 8.86 % with ESC, while the average hospital stay was 16.0 ± 3.1 and 22.0 ± 2.2 days, respectively. In 1149 cases (22.98 %), plastic techniques were required: modified autodermoplasty in 953 (19.06 %) and flap reconstructions in 196 (3.92 %). These methods enabled the closure of extensive defects but were associated with higher complication rates (25.6–67.9 %) and longer hospital stays (23.0–36.8 days).

Conclusions. The use of PRP in combination with delayed primary or early secondary closure is the most effective and safe treatment strategy for small, isolated gunshot shrapnel wounds of soft tissues, ensuring low complication rates and faster functional recovery. Autodermoplasty and flap techniques remain the methods of choice for large and deep defects but require advanced surgical expertise and are associated with longer rehabilitation.