Relevant aspects of the interaction of any missile and the body can be understood by considering a single model Fig. A bullet from a modern assault rifle entering a medium of density similar to that of soft tissue does not release its energy uniformly along the track, nor does it continue to penetrate point-forward.
The transfer of kinetic energy to the surrounding Quest For Control - Blizzard / Violation Wound - Antimusic Missile increases as the bullet turns over usually after cm and presents a greater area in relation to the direction in which it is travelling.
As the bullet destabilizes, it then comes to rest pointing backwards. In simple terms, a bullet imparts more of its kinetic energy to the tissue as it loses stability and turns over. A bullet with less than a certain velocity which therefore carries less than a certain kinetic energy may not turn over, so leaving a simple track. Figure 1. All bullets produce variations on this depending on calibre, velocity and construction.
The inset box indicates the individual small track of one fragment should the bullet disrupt. The factors that determine the relative shape, length and width of each section of the bullet's track are the same as those that determine whether a missile causes tissue damage in a wound and are summarized in Table 1. The exact relationship between the track left in an inelastic medium such as soap, the 'temporary cavity' seen in gelatin and the wound sustained in the field has not been established.
However, one can safely assume that the widest portion of the track is where there has been greatest transfer of energy and therefore represents the most tissue damage. A clinical photograph of a wound which corresponds to the model is shown in Figure 1. Different sections of the track in Figure 1. If Calendar Song (January, February, March.) - Boney M.
- Oceans Of Fantasy part of the body injured is represented by the section of the block A to B, this explains how a bullet, even of high velocity, can cause a wound with little tissue damage, i. If the section is A to C, this gives the profile of a classical gunshot wound with a small entry and large exit.
The section A to D is more unusual but explains how a wound with much tissue damage can have a small entry and a small exit; such wounds tend to have long tracks through the body. Occasionally, a bullet makes a large entry; this is explained by it being rendered unstable before impact ricochet and therefore represents the C to D or C to E sections, depending on whether it makes an exit or not.
A round entry indicates a higher fragment velocity and therefore increased likelihood of tissue damage. The entry, unseen, is high on the left buttock. The missile passed across the pelvis without injury of the rectum or bladder nor breach of the peritoneum, and made Pants - Venkman - Slumber Party exit between the anus and scrotum.
It then entered the patient's right thigh larger wound and made its second exit slightly lower smaller wound. The score for these wounds according to the Red Cross classification of wounds is:.
Impact by an unstable bullet section C to D or C to E is important because it is similar to wounds caused by irregularly shaped fragments; it explains the funnel shape of these wounds and their small exit. It also shows how, in fragment wounds, the tissue damage is predominantly at the entry, the track is Quest For Control - Blizzard / Violation Wound - Antimusic Missile short and the missile itself comes to rest in tissue to which it has imparted little energy, i.
Special features of fragment wounds are summarized in Table 1. Of particular importance is the shallow penetration of small fragments from, for example, modern hand grenades; many such wounds do not need operative management.
Should a bullet be designed to disrupt on impact fragment, flatten or musique pour la danse - Antoine Corriveau - Cette Chose qui cognait au creux de sa poitrine sans vouit dissipates a greater proportion of its energy over a shorter distance and does so within a few centimetres of the entry.
A steel-jacketed military bullet may also disrupt but does so as it turns over in the medium; it breaks in the middle as a result of side-flattening. Whichever, each small bullet fragment produces its own funnel-shaped wound a smaller version of wound C to E away from the wound Floor Me - Various - Audio Dope v.I (File), as shown in the inset in Figure 1.
This explains the severity of wounds from bullets which disrupt Fig. Tissue death is caused primarily by laceration, stretching and crushing. The importance of a shock-wave effect is not known. Despite laboratory work on the subject, the relationship between cavitation and tissue death remains unclear, although it is known that it increases the volume of damaged tissue, probably by stretching.
Much depends on the density and elasticity of the surrounding tissues. It has been established that the phenomenon of temporary cavitation contributes to the introduction of pathogens and foreign material, particularly clothing, into the wound by a sucking mechanism.
The picture is further complicated by a missile's The Apes - Street Warz with bone. The missile is retarded more, causing higher energy transfer over a shorter distance. A bullet is not only retarded but also destabilized by contact with bone and is more likely to disrupt.
The result is a larger wound and comminution of bone Fig. Such wounds should not be considered simply as fractures; they are a complex mixture of dead and contaminated soft tissue surrounding the bone fragments. The importance of bone fragments acting as secondary missiles is questionable.
The multiple metallic fragments from a disrupted bullet are clearly visible. There is not an associated fracture F0, M2. Both the multiple fragments of the bullet jacket and the specks of lead are visible. The extensive comminution of bone is evident F2, M2. The demarcation between culture medium dead tissue and normal tissue is not sharp; there is tissue that is affected by the injury Quest For Control - Blizzard / Violation Wound - Antimusic Missile which is not dead.
This tissue is ischaemic due to vasospasm in response to injury and compression by swelling of adjacent muscle; both factors are relevant and may coexist. The existence of this adjacent ischaemia is important because it provides for extension of the culture medium and it is reversible. The complexity of energy transfer and the involvement Acidic Brutality - Luna-C - The Luna-C Project 2 bone in a wound explain the variety of missile wounds; Quest For Control - Blizzard / Violation Wound - Antimusic Missile and the presence of reversibly ischaemic tissue explain the failure of a single model to provide rules for wound surgery.
Printable version. Export document as PDF file. Missile wounds Relevant aspects of the interaction of any missile and the body can be understood by considering a single model Fig. Table 1. Variation in size Usually multiple Entry larger than exit if made Short track Tissue damage near the entry A round entry indicates a higher fragment velocity and therefore increased likelihood of tissue damage.
Expand Document. Expand Chapter. Full TOC. Protection of health in war. Missile wounds. Explosive wounds. Wound infection. Prevention of infective complications. Wound assessment. The operation of wound excision. Dressings for open wounds. Wound closure. Case 1 Large wound of a child's left arm with a fracture of the humerus. Case 2 Bullet wounds of the thigh with a femur fracture.
Case 3 Antipersonnel mine injury of the leg: multiple mud injections with simple fracture of the tibia. Wounds of bone. Bone healing and methods of fracture immobilization. Regional fracture immobilization. Bone grafts. Wounds of joints. Hand wounds. Chronic bone exposure. Physiotherapy for limb wounds. Case 4 Bullet wound of the thigh: external fixation. Case 5 Hand injured by exploding device.
Pathological aspects of severe limb injury. Operative considerations. Specific amputations in relation to war wounds. Stump revision. Rehabilitation of the amputee. Case 6 Medial gastrocnemius myoplastic below-knee amputation for antipersonnel mine injury.
Case 7 Bilateral vastus medialis above-knee myoplastic amputation for severe antipersonnel mine injury. Vascular wounds. Compartment syndrome. Case 8 Popliteal vessel wound with little tissue damage; Antonio Olivieri - Rudiments repair. Case 9 Popliteal vessel wound with tissue damage; vessel ligation.
Reconstructive surgery. Case 10 Bullet wound of the arm and forearm; external fixation and abdominal skin flap. Case 11 Bullet wound of the upper tibia and knee; lateral gastrocnemius myoplasty.
The patient with severe limb Quest For Control - Blizzard / Violation Wound - Antimusic Missile . Children's limb wounds. Managing limb wounds in difficult situations. Appendix 1 The Red Cross wound classification. Appendix 2 Figures from the Red Cross database.