The physics, pathophysiology, and management of high velocity gunshot wounds

The authors report on a gunshot wound of the foot with subsequent infection and nonunion. The pathophysiology of a gunshot wound is discussed with special emphasis on the temporary cavity and permanent cavity produced, and how this affects skin, subcutaneous tissue, muscle, and bone. The prognosis of a given wound is also determined by a thorough examination of the bullet design, its velocity, and potential for tissue disruption. Proper management of the wound is discussed relative to debridement technique and surgical care. Four principles of management for gunshot wounds include recognition or diagnosis, reduction, retention or immobilization, and restoration of function. Some of the pitfalls are discussed including inadequate assessment of the wound relating to its extent and mismanagement.