Even though shotgun injuries are often grouped with gunshot wounds, the former are ballistically and clinically far different from gunshot wounds. Two groups of patients with shotgun and gunshot wounds of the extremities, respectively, were compared with regard to clinical features. Although the vascular wound was the most dramatic aspect in both groups of patients, associated injuries, especially to the nerves and bones, played a significant role in the ultimate rehabilitation of the patients with shotgun wounds. Shotgun injuries more frequently required the use of saphenous vein grafts than did gunshot wounds. The infection and amputation rates were much higher in patients with shotgun wounds than in those with gunshot wounds. Patients with shotgun injuries of the extremities often required secondary reconstructive procedures such as tendon transfer or bone and joint fusion. Despite these measures the outlook for the ultimate rehabilitation of the extremity after shotgun injury was dismal, whereas after gunshot wounds complete rehabilitation was the rule.