Wound ballistics of gunshot injuries to the head and neck.
ABSTRACT It is important for the trauma surgeon to understand the basic principles of terminal gunshot ballistics and the study of the projectile's effect on striking soft tissue. The amount of kinetic energy dissipated to the tissue is directly related to the mass and velocity of the projectile as follows: K = MV2/2. Doubling the velocity quadruples the energy, while doubling the mass only doubles the energy. A temporary tissue cavity is produced as the striking projectile compresses the surrounding tissue; the higher the energy release, the more extensive the inapparent compressive damage. The permanent cavity that remains is the result of extrusion of tissue from the pathway of the projectile. The higher the velocity, the higher the likelihood of extensive damage. If the missile expands or fragments within the tissues, more damage will occur.
- SourceAvailable from: onlinelibrary.wiley.com[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVES/HYPOTHESIS: The objectives are to compare and contrast the head and neck trauma experience in Iraq and Afghanistan and to identify trauma lessons learned that are applicable to civilian practice. STUDY DESIGN: A retrospective review of one head and neck surgeon's operative experience in Iraq and Afghanistan was performed using operative logs and medical records. METHODS: The surgeon's daily operative log book with patient demographic data and operative reports was reviewed. Also, patient medical records were examined to identify the preoperative and postoperative course of care. RESULTS: The head and neck trauma experiences in Iraq and Afghanistan were very different, with a higher percentage of emergent cases performed in Iraq. In Iraq, only 10% of patients were pretreated at a facility with surgical capabilities. In Afghanistan, 93% of patients were pretreated at such facilities. Emergent neck exploration for penetrating neck trauma and emergent airway surgery were more common in Iraq, which most likely accounted for the increased perioperative mortality also seen in Iraq (5.3% in Iraq vs. 1.3% in Afghanistan). Valuable lessons regarding soft tissue trauma repair, midface fracture repair, and mandible fracture repair were learned. CONCLUSION: The head and neck trauma experiences in Iraq and Afghanistan were very different, and the future training for mass casualty trauma events should reflect these differences. Furthermore, valuable head and neck trauma lessons learned in both war zones are applicable to the civilian practice of trauma. LEVEL OF EVIDENCE: Level 4. Laryngoscope, 2013.The Laryngoscope 04/2013; · 1.98 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Though modern civilian neurosurgical practice frequently encounters unusual penetrating injuries of cranium and spine; penetrating nail injuries to neck are very rarely described. We describe the case of a 24 year old male who suffered such an injury from a nail gun. The history, radiological studies and treatment are presented. Mechanism of injury seems to share characteristics of low velocity projectiles. We discuss the management of this unusual case reviewing the current literature on penetrating neck injuries caused by similar objects.Indian Journal of Neurotrauma. 01/2009;
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction A prospectively randomised, controlled animal study was conducted to analyse the influence of vagal injury on acute cardio-respiratory responses to blast injury. Materials and methods We used a previously described model of blast-fragment combined injuries to divide dogs randomly into three groups: normal control, blast injury with fragment shot at the masseter and blast injury with fragment shot at the neck. The vagal histomorphologic changes were investigated by haematoxylin–eosin staining and immunocytochemical analysis of neuron-specific enolase and glial fibrillary acidic protein. The indices of respiration, heart rate, blood pressure and body temperature were recorded continuously before and after blast exposure. Results The vagal injury was more severe in the neck-injured than in the face-injured group. However, bradycardia, hypotension and absence of compensatory peripheral vasoconstriction, which are typically seen in animals subjected to blast injury without vagal nerve injuries, were partly inhibited when the vagal nerve was injured. Conclusion A vagally mediated reflex, such as a cardio-respiratory system defensive reflex that caused shock, was observed immediately after blast pressure wave injury. These observations may have important implications for the emergency management of blast injury cases.European Journal of Trauma and Emergency Surgery 39(4). · 0.26 Impact Factor