J Korean Med Assoc.  2012 May;55(5):463-472. 10.5124/jkma.2012.55.5.463.

Mechanisms of injury and treatment principles of gunshot wounds

• Lee CH

• KMID: 2064803
• DOI: http://doi.org/10.5124/jkma.2012.55.5.463

Abstract

Gunshot wounds have been an important source of injury for centuries and continue to occur. The military medical communities have developed standard procedural sequences and principles that may assist and serve as references to the care of civilian gunshot wound patients. In addition to the basic understanding of the wounding patterns and potential extent of the damage caused by the ballistic characteristics of the missile, three principles need to be emphasized in the course of the treatment: timely debridement, delivery of antibiotics, and delayed closure of the wound. Despite recent innovations and improvements in medicine, the three principles still stand, and may assist even surgeons with minimal experience in treating gunshot wounds to achieve reliable results. The situation and environment of civilian medical facilities differ from those of the military in war time, and less invasive and more conservative methods may be attempted in accordance with available resources.

Keyword

Gun-shot wound; Ballistics; Bullet; Debridement

MeSH Terms

Anti-Bacterial Agents
Debridement
Forensic Ballistics
Humans
Military Personnel
Wounds, Gunshot
Anti-Bacterial Agents

Figure

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  Figure 1 Projectile-tissue interaction, showing components of tissue injury (From US Department of Defense. Emergency war surgery. [Washington, DC]: US Department of Defense; 2004) [4].

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  Figure 2 Factors acting on a projectile in flight.

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  Figure 3 Deviation and yaw of a spun projectile in flight.

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  Figure 4 Yaw between the axis of the projectile and the line of flight.

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  Figure 5 Hypothesized wound profile of a high velocity Spitzer bullet.

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  Figure 6 Algorithm for management of soft-tissue gun-shot wound (From Bellamy RF, et al. Conventional warfare: ballistic, blast, and burn injuries. Part 1. Warfare, weaponry, and the casualty. Washington, DC: Office of the Surgeon General at TMM Publications; 1991) [3].

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