The effect of military clothing on gunshot wound patterns in a cadaveric animal limb model

Tom Stevenson,Sarah A Stapley,Iain E Gibb,Debra J Carr

doi:10.1007/s00414-019-02135-9

Tom Stevenson, Sarah A Stapley + Show 2 more

Open Access

https://doi.org/10.1007/s00414-019-02135-9

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Abstract

The majority of injuries in survivors of gunshot wounds (GSW) are typically to the extremities. Novel wound ballistic research is encouraged to try and capture corporate knowledge on the management of these injuries gained during recent conflicts and understand the wounding patterns seen. With recent work examining the effect of UK military clothing on extremity GSW patterns in a synthetic model, a model with greater biofidelity is needed for ballistic testing. The aim of this study was to assess the effect of UK military clothing on GSW patterns within a cadaveric animal limb model using two types of ammunition commonly used in recent conflicts—7.62 × 39 mm and 5.45 × 39 mm. In total, 24 fallow deer hind limbs were shot, 12 by 7.62 mm projectiles and the remaining 12 shot by 5.45 mm projectiles, further divided into four with no clothing layers (Cnil), four with a single clothing layer (Cmin) and four with maximum clothing layers (Cmax) as worn on active duty by UK military personnel. Limbs were analysed after ballistic impact using contrast CT scanning to obtain measurements of permanent cavity damage, and results were compared using analysis of variance (ANOVA). Results showed significantly different damage measurements within limbs with Cmax for both ammunition types compared with the other clothing states. This may result in GSWs that require more extensive surgical management, and invites further study.

Highlights

Whilst fragmentation injuries typically dominate the amount of combat trauma seen in war, gunshot wounds (GSW) are still responsible for extensive numbers within military casualty statistics throughout numerous major conflicts [1,2,3,4,5,6,7,8]
The same standard issue Multi-Terrain Pattern (MTP) UK military clothing states were chosen: a nil clothing state, i.e. no clothes (Cnil), a minimal clothing state, i.e. a single clothing layer taken from MTP trousers (Cmin) or a maximum clothing state (Cmax), i.e. clothing layers taken from a t-shirt, Under Body Armour Combat Shirt (UBACS), smock and upper arm brassard as worn by UK service personnel (Fig. 1) [29]
Mean impact velocity for the 7.62 mm projectiles was 645 m/s (SD = 8 m/s) and for the 5.45 mm projectiles was 907 m/s (SD = 25 m/s), which were as expected for these ammunition types following previous work [29]

Summary

Introduction

Whilst fragmentation injuries typically dominate the amount of combat trauma seen in war, gunshot wounds (GSW) are still responsible for extensive numbers within military casualty statistics throughout numerous major conflicts [1,2,3,4,5,6,7,8]. Most recently during the Iraq and Afghanistan conflicts between 2003 and 2014, 24% of all UK military trauma casualties were due to gunshot, making it the second most common mechanism of injury after blast, with 69% of those GSW survivors suffering extremity wounding [8]. Management of these cases have seen the rapid evolution of clinical practice to try and mitigate the complex nature of these injuries [9, 10]. As such the use of human or animal tissue is sometimes required to understand the complex interactions faced with a projectile when it enters the anatomy [16,17,18,19,20]

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