Abstract
One major cause of traumatic injury is firearm-related wounds (i.e., ballistic trauma), common in both civilian and military populations, which is increasing in prevalence and has serious long-term health and socioeconomic consequences worldwide. Common primary injuries of ballistic trauma include soft-tissue damage and loss, haemorrhage, bone fracture, and pain. The majority of injuries are of musculoskeletal origin and located in the extremities, such that skeletal muscle offers a major therapeutic target to aid recovery and return to normal daily activities. However, the underlying pathophysiology of skeletal muscle ballistic trauma remains poorly understood, with limited evidence-based treatment options. As such, this review will address the topic of firearm-related skeletal muscle injury and regeneration. We first introduce trauma ballistics and the immediate injury of skeletal muscle, followed by detailed coverage of the underlying biological mechanisms involved in regulating skeletal muscle dysfunction following injury, with a specific focus on the processes of muscle regeneration, muscle wasting and vascular impairments. Finally, we evaluate novel approaches for minimising muscle damage and enhancing muscle regeneration after ballistic trauma, which may have important relevance for primary care in victims of violence.
Highlights
Traumatic injuries have a major impact on society, contributing to around 10% of global disease burden[1]
Firearm incidents are under more scrutiny than ever: nearly half of all global homicides can be attributed to firearms[3] while there has been a sharp rise over recent years in lone terrorist gun attacks across developed nations such as Canada, USA, Norway, and the UK, which has attracted huge media attention
We provide an in-depth analysis of the underlying biological mechanisms responsible for regulating skeletal muscle dysfunction following traumatic injury, including the interlinked processes of muscle regeneration, muscle wasting and vascular impairments
Summary
Traumatic injuries have a major impact on society, contributing to around 10% of global disease burden[1]. One major cause of traumatic injuries is firearm-related wounds (i.e., ballistic trauma), which are common occurrences in both civilian and military populations. We will review basic trauma ballistics and the immediate damage they inflict on skeletal muscle, followed by what modern clinical management procedures are in place to deal with such injuries. The extent of the firearm wound (i.e., depth and area damaged) is highly dependent upon projectilethe clinical literature nearly a century later His observations were tissue characteristics, whereby both the projectile (e.g., velocity, on a wide canvas, including the context that ‘Fire arms and spirits mass, shape, calibre, material, yawing and impact distance) and are the first of our refinements that are adopted in uncivilised countries’. Various routes with laceration, contusion/crush injury, denervation npj Regenerative Medicine (2021) 17
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