A civilian perspective on ballistic trauma and gunshot injuries

Abstract

BackgroundGun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities.MethodsA search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.ResultsCraniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.ConclusionThe treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.

Management of ballistic soft tissue injuries: a review

“…The results of reviewed articles [8,[11][12][13][14][15][16][17] are summarized in chronological order in Table 1. Following initial wound care, the next step in the subsequent management of soft tissue injuries usually involves definitive reconstruction.…”

“…Although it has been common practice to surgically operate on all ballistic wounds, recent literature suggests that some carefully selected wounds could be treated non-operatively by irrigation, dressing and antibiotics [8,[11][12][13][14]. Such ballistic wounds selected for non-operative management are ideally low-energy wounds, usually involving limited soft tissue damage.…”

“…Such ballistic wounds selected for non-operative management are ideally low-energy wounds, usually involving limited soft tissue damage. Other small, isolated wounds involving only the skin, subcutaneous tissues and muscle could also be appropriately managed with irrigation, superficial debridement, dressings and antibiotics [14]. Usually direct closure of the wound is not recommended as it is preferable to leave the wound to heal by second intention [8,11,[13][14][15][16].…”

“…On the other hand, wounds which have sustained severe soft tissue damage and contain non-viable tissue have been successfully treated with excision of the wound margins and track, removal of injured subcutaneous fat and fascia, appropriate debridement of devitalized tissues, irrigation and removal of foreign bodies as required [11][12][13][14][15][16]. Regarding debridement, new recommendations for initial extremity war wound debridement have recently been published [16].…”

Outpatient Management Of Low Velocity Gunshot Wound Experience In United Nations Level-Ii Hospital

“…Sonic pressure wave is of short duration, precedes bullet and does not cause much tissue destruction. Permanent cavitations is caused mainly by crushing and laceration of tissues along the missile track 3,4 . In low energy transfer wound tissue destruction is confined to wound track producing permanent cavity and is proportional to the size of the projectile.…”