Ballistic injury

Wound profiles made under controlled conditions in the wound ballistics laboratory at the Letterman Army Institute of Research showed the location along their tissue path at which projectiles cause tissue disruption and the type of disruption (crush from direct contact with the projectile or stretch from temporary cavitation). Comparison of wound profiles showed the fallacy in attempting to judge wound severity using velocity alone, and laid to rest the common belief that in treating a wound caused by a high-velocity missile, one needs to excise tissue far in excess of that which appears damaged. All penetrating projectile wounds, whether civilian or military, therefore should be treated the same regardless of projectile velocity. Diagnosis of the approximate amount and location of tissue disruption is made by physical examination and appropriate radiographic studies. These wounds are contaminated, and coverage with a penicillin-type antibiotic should be provided.