General Concepts

The medical literature is full of erroneous articles classifying gunshot wounds based on bullet velocity. Other bullet and tissue characteristics are at least as important as velocity.67 and 8 Bullet mass, which is related to diameter and length, is a major determinant of how deeply the bullet will penetrate tissue. Bullet construction (such as whether the bullet is solid lead with no bullet jacket, is partially jacketed, or has a full metal jacket) is a primary determinant of whether the bullet will deform or fragment. Bullet shape and center of mass (which determine how soon it will yaw in its path through tissue), the thickness of the body part wounded (determining whether the bullet has a long enough path through tissue to deform or yaw) ( Fig... . . .256-1), tissue type struck (e.g., femur versus lung), tissue elasticity, density, specific gravity, and internal cohesiveness [which determine how well the tissue will withstand tissue stretch (temporary cavitation) forces] are all important, in addition to bullet velocity, in determining the nature of the wound produced. The amount of kinetic energy "deposited" or "retained" in a victim wounded by a projectile is not a reliable predictor of wound severity,9 and muzzle energy is not a reliable indicator of bullet performance.

M16 Bullet Wounds

FIG. 256-1. A. The photograph shows a .22 long rifle round (left) and an M16 round (right). B and C. These are the wound profiles of the same .22 long rifle (B) and .224 caliber M-193 round of the M16A1 rifle (C). [Full metal case (FMC) is a synonym of full metal jacket (FMJ), the type of bullet used in the military.] This figure shows that caliber (bullet diameter in decimals of an inch or in millimeters) is only one indicator of wounding potential and not a very good one. Because of much higher velocity [3094 ft/s (943 m/s), as opposed to 1122 ft/s (342 m/s) for the .22 long rifle bullet], because it fragments in tissue, and because of greater bullet mass, the M16 bullet has the potential to cause a much more severe wound if the anatomic part struck is sufficiently thick. Note that, in the gelatin block, both the permanent cavity and the temporary cavity caused by the M16 bullet are much larger than those of the .22 long rifle bullet. As is usual for a non-deforming bullet, the temporary and permanent cavities caused by the .22 long rifle bullet are largest when the bullet has a 90° yaw. (From Hollerman et al (p 686), 4 with permission.)

An understanding of wound ballistics enables physicians to evaluate and treat missile wounds without repeating the errors of conventional "wisdom." Based on common misconceptions about wound ballistics, many papers have suggested harmful and unnecessary treatment for gunshot wounds. An example of such an unnecessary and harmful recommendation is that for mandatory surgical excision of the tissue surrounding the bullet track (the path of the projectile through tissue) whenever an extremity wound is caused by a high-velocity bullet. This is based on the belief that these tissues will become necrotic. Clinical experience and research show this to be false.10

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