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High velocity gunshot injuries to the extremities: management on and off the battlefield

  • Gunshot Wounds and Blast Injuries (D Stinner and MK Sethi, Section Editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

The gunshot wounds sustained on the battlefield caused by military ammunition can be different in nature to those usually encountered in the civilian setting. The main difference is that military ammunition has typically higher velocity with therefore greater kinetic energy and consequently potential to destroy tissue. The surgical priorities in the management of gunshot wounds are hemorrhage control, preventing infection, and reconstruction. The extent to which a gunshot wound needs to be surgically explored can be difficult to determine and depends on the likely amount of tissue destruction and the delay between wounding and initial surgical treatment. Factors associated with greater energy transfer, e.g., bullet fragmentation and bony fractures, are predictors of increased wound severity and therefore a requirement for more surgical exploration and likely debridement. Gunshot wounds should never be closed primarily; the full range of reconstruction from secondary intention to free tissue transfer may be required.

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Acknowledgments

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors are all serving medical officers in the UK Armed Forces.

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Conflict of Interest

None of the authors have any conflicts of interest with the subject of this work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), ICT Research Park, Vincent Drive, Edgbaston, Birmingham, B15 2SQ, UK

    Jowan G. Penn-Barwell, Kate V. Brown & C. Anton Fries

Authors
  1. Jowan G. Penn-Barwell
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  2. Kate V. Brown
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  3. C. Anton Fries
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Correspondence to Jowan G. Penn-Barwell.

Additional information

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Ministry of Defence or Her Majesty’s Government.

© Crown Copyright 2015

This article is part of the Topical Collection on Gunshot Wounds and Blast Injuries

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Penn-Barwell, J.G., Brown, K.V. & Fries, C.A. High velocity gunshot injuries to the extremities: management on and off the battlefield. Curr Rev Musculoskelet Med 8, 312–317 (2015). https://doi.org/10.1007/s12178-015-9289-4

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  • DOI: https://doi.org/10.1007/s12178-015-9289-4

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