• P K Stefanopoulos, D E Pinialidis, G F Hadjigeorgiou, and K N Filippakis.
• The First Department of Surgery, 401 Army Hospital, 138 Mesogeion Ave., 11525, Athens, Greece. pan.stefanopoulos@gmail.com.
• Eur J Trauma Emerg Surg. 2017 Oct 1; 43 (5): 579-586.

PurposeThe mechanisms of soft tissue injury by bullets are reviewed, in the belief that the current incidence of firearm injuries in many urban areas necessitates an understanding of wound ballistics on the part of trauma surgeons who may not be familiar with the wounding factors involved.MethodsReview of the literature, with technical information obtained from appropriate non-medical texts.ResultsDespite numerous publications concerning the treatment of gunshot wounds, relatively few papers contain details on the mechanisms of ballistic trauma, with the main body of evidence derived from previous laboratory and animal studies which have only recently been systematically appraised. These studies have shown that in rifle injuries the main wound tract is surrounded by an area of damaged tissue as a result of the temporary cavitation induced once the bullet becomes destabilized or deformed. On the other hand, the more commonly encountered non-deforming handgun bullets cause damage limited to the bullet's path, mainly as a result of localized crush injury.ConclusionsThe bullet's construction and ballistic behavior within tissue determine to what extent the previously overestimated velocity factor may influence wound severity. The damage produced from temporary cavitation depends on the tensile properties of the tissues involved, and in high-energy injuries may lead to progressive muscle tissue necrosis. Therefore, the term "high-energy" should be reserved for those injuries with substantial tissue damage extending beyond the visible wound tract.

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