Missile and explosive wounds

Abstract

Approximately half a million people are killed worldwide each year by firearms. Ballistic injury is uncommon in the UK, but confusion may arise if such injuries present to Accident and Emergency Departments. The combination of confusion and an unfamiliar injury pattern is not ideal in the resuscitation of injured casualties, and the situation is worse if there are multiple casualties. One must be familiar with the concepts of ballistic injury and its pathophysiology to minimize the adverse effects; understanding energy transfer and the clinical consequences of ballistic wounding guide subsequent management. The physics of blast can be complex, but an awareness of the basic principles clarifies how injuries are produced and their severity. The basic principles of war surgery are detailed, and the concept of damage-control surgery in the management of missile and explosive wounds in the physiologically exhausted patient is discussed.