High-Power Slugs Cause More Trauma


Wounds produced by automatic and semiautomatic weapons are much more difficult to treat than conventional bullet wounds because the high-velocity slugs produce disproportionately high amounts of tissue damage, trauma experts say.

With conventional weapons, the size of the injury is directly related to the size of the slug, and little damage is done to surrounding tissues. The wound can be fatal if the bullet directly strikes a crucial organ, but otherwise repairing the damage is a relatively straightforward process, according to Dr. Fred Weaver, a surgeon at County-USC Medical Center.

But the much higher velocity of a slug from an automatic or semiautomatic weapon causes much more energy to be released into soft tissues surrounding the path of the bullet. The energy released from the high-velocity slugs causes nearby cells to literally explode and die, he said, making treatment quite complex.

A typical injury from a high-velocity weapon thus has the shape of a cone--narrow where the bullet enters and broadening as it passes through the body, ultimately leaving the body through exit sites that "can be huge holes with massive tissue destruction," Weaver said.

It is the management of this secondary tissue damage that will be the primary lesson for Army surgeons at Martin Luther King/Drew Medical Center.

The first steps in treatment are controlling bleeding and repairing damage to internal organs. Surgeons then remove all the dead tissue surrounding the wound. Tissue may continue to die for as long as 48 hours, so surgeons re-examine the wounds after a day or two to remove additional dead tissue.

If the dead tissue is not removed, it can lead to infection.

Finally, the entrance and exit wounds have to be closed by plastic surgery, a process that "really has to be individualized," Weaver said. The wounds are typically covered with a flap of skin and fat from elsewhere on the body. "It sometimes takes very creative plastic surgery to close wounds and provide coverage" of the holes, Weaver said.

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