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Wound ballistics 101: the mechanisms of soft tissue wounding by bullets

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Abstract

Purpose

The mechanisms of soft tissue injury by bullets are reviewed, in the belief that the current incidence of firearm injuries in many urban areas necessitates an understanding of wound ballistics on the part of trauma surgeons who may not be familiar with the wounding factors involved.

Methods

Review of the literature, with technical information obtained from appropriate non-medical texts.

Results

Despite numerous publications concerning the treatment of gunshot wounds, relatively few papers contain details on the mechanisms of ballistic trauma, with the main body of evidence derived from previous laboratory and animal studies which have only recently been systematically appraised. These studies have shown that in rifle injuries the main wound tract is surrounded by an area of damaged tissue as a result of the temporary cavitation induced once the bullet becomes destabilized or deformed. On the other hand, the more commonly encountered non-deforming handgun bullets cause damage limited to the bullet’s path, mainly as a result of localized crush injury.

Conclusions

The bullet’s construction and ballistic behavior within tissue determine to what extent the previously overestimated velocity factor may influence wound severity. The damage produced from temporary cavitation depends on the tensile properties of the tissues involved, and in high-energy injuries may lead to progressive muscle tissue necrosis. Therefore, the term “high-energy” should be reserved for those injuries with substantial tissue damage extending beyond the visible wound tract.

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Acknowledgments

The authors acknowledge the help and authoritative advice of Dr. Leslie Payne, Honorary Secretary to the UK GEMS and the Ballistic Injury Archives of the Royal Defence Medical Centre.

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Author notes

  1. P. K. Stefanopoulos

    Present address: , Pafsaniou 4, 22100, Tripolis, Greece

Authors and Affiliations

  1. The First Department of Surgery, 401 Army Hospital, 138 Mesogeion Ave., 11525, Athens, Greece

    P. K. Stefanopoulos, D. E. Pinialidis & K. N. Filippakis

  2. The Department of Neurosurgery, Korgialenio-Benakio Red Cross Hospital, Erithrou Stavrou & Athanasaki Str., Ampelokipi, 11526, Athens, Greece

    G. F. Hadjigeorgiou

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Correspondence to P. K. Stefanopoulos.

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The authors declare that they have no conflict of interest: Panagiotis K. Stefanopoulos declares that he has no conflict of interest. Dionisios E. Pinialidis declares that he has no conflict of interest. Georgios F. Hadjigeorgiou declares that he has no conflict of interest. Konstantinos N. Filippakis declares that he has no conflict of interest.

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Stefanopoulos, P.K., Pinialidis, D.E., Hadjigeorgiou, G.F. et al. Wound ballistics 101: the mechanisms of soft tissue wounding by bullets. Eur J Trauma Emerg Surg 43, 579–586 (2017). https://doi.org/10.1007/s00068-015-0581-1

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