The wound ballistics literature contains several misconceptions about the physical effects of penetrating projectiles in tissue and tissue simulants. These can adversely affect the proper management of gunshot injuries, particularly in view of the ongoing threat of terrorist and criminal acts using assault rifles against civilians. The understanding of the wounding effects by military rifle bullets can be founded on the concept of energy transfer to the wound as applied to high-energy missile trauma. A substantial component of high-energy transfer in assault rifle injuries is manifested by the dynamic phenomenon of temporary cavitation, which is extensively reviewed with respect to its impact on the wound production and the associated controversy surrounding its consequences in soft tissue wounds. Part of this controversy emanates from misinterpretation of experimental data regarding the magnitude of the temporary cavity induced by high-velocity projectiles and the different conceptions of the tissue response to cavitation. The interaction between the projectile and tissue can lead to tumbling and possibly to deformation and fragmentation of the bullet, all of which strongly influence the energy transfer characteristics affecting both the temporary cavitation and the size of the permanent wound channel. Awareness of these effects can enhance perception of clinical and radiological findings suggestive of the wounding mechanism by various projectiles. LEVEL OF EVIDENCE: Review/therapeutic, level V.

Wound ballistics of military rifle bullets: An update on controversial issues and associated misconceptions.

The application of medical waterjet achieves non-rigid separation of soft tissues. The separation effect is the result of the interaction between hydrodynamic and biomechanical nonlinear responses. In this study, a non-rigid cutting model of soft tissue was established based on fracture mechanics and energy conversion processes. It can clearly explain the physical reasons for the advantages of non-rigid separation: The extremely high impact speed, which is difficult to achieve through rigid separation, makes the stress and deformation of the soft tissue smaller. The non-rigid cutting model reveals the impact mechanism of waterjet impact velocity or pressure on the static separation effect. Based on the experimental observation of the physical morphology during the interaction process and the measurement of the dynamic separation rate, imaging evidences for dynamically evaluating the separation effect were proposed. The method of adjusting the separation effect including the splashing behavior of the waterjet was verified. The research results precisely link the application requirements of precision surgery with the physical form of the interactive process, establish a physical basis for expanding the advantages of non-rigid separation of soft tissue and provide guidance for the evaluation of dynamic separation effects.

Non-rigid cutting of soft tissue: physical evidences of complex mechanical interaction process of soft materials

Different from the rigid separation of biological tissue by scalpel, medical waterjet technology utilizes the impact kinetic energy of high-speed waterjet to instantly destroy the surface of biological tissue to achieve better clinical separation effect. Since the gelatin samples are transparent biomaterials, they were taken as the only substitute for soft tissue in experimental studies and observation in the current studies of medical waterjet separation technology, but the mechanical behavioural difference between the two has not been reported. To verify the adaptability of gelatin as a substitute of soft tissue under the impact of high-speed waterjet. Firstly, the dynamic process of impact was described through the energy balance equation. Then, based on the principle of altering a single variable, the difference of damage depth between 8 wt. %, 10 wt. %, and 12 wt. % gelatin samples and porcine liver tissue under various impact pressure, impact distance, and waterjet speed of motion (as opposed to flow velocity) was compared. The results show that the gelatin sample replicates the damage behaviour of porcine liver samples under the specific waterjet impact conditions, and the direction of the waterjet hydraulic power optimisation of the two materials is also consistent: however, due to the different sampling sites and anisotropy of porcine liver samples, the mechanical response of soft tissue under high-speed waterjet impact cannot be fully expressed by gelatin samples. The experimental results can provide support for the further study of medical waterjet separation technology.

Separation Behaviour Difference Between Gelatin and Porcine Liver Under High-Speed Waterjet Impact

As a natural polymer, gelatin is increasingly being used as a substitute for animals or humans for the simulation and testing of surgical procedures. In the current study, the similarity verification was neglected and a 10 wt.% or 20 wt.% gelatin sample was used directly. To compare the mechanical similarities between gelatin and biological tissues, different concentrations of gelatin samples were subjected to tensile, compression, and indentation tests and compared with porcine liver tissue. The loading rate in the three tests fully considered the surgical application conditions; notably, a loading speed up to 12 mm/s was applied in the indentation testing, the tensile test was performed at a speed of 1 mm/s until fracture, and the compression tests were compressed at a rate of 0.16 mm/s and 1 mm/s. A comparison of the results shows that the mechanical behaviors of low-concentration gelatin samples involved in the study are similar to the mechanical behavior of porcine liver tissue. The results of the gelatin material were mathematically expressed by the Mooney-Rivlin model and the Prony series. The results show that the material properties of gelatin can mimic the range of mechanical characteristics of porcine liver, and gelatin can be used as a matrix to further improve the similarity between substitute materials and biological tissues.

/pdf/study-on-the-similarity-of-biomechanical-behavior-between-292fexku65.pdf

Study on the Similarity of Biomechanical Behavior between Gelatin and Porcine Liver

Abstract Partial-thickness cutaneous injuries distributed over exposed body locations, such as the face and extremities, pose a significant risk of infection, function loss, and extensive scarring. These injuries commonly result from impact of kinetic debris from industrial accidents or blast weaponry such as improvised explosive devices. However, the quantitative connections between partial-thickness injuries and debris attributes (kinetic energy, shape, orientation, etc.) remain unknown, with little means to predict damage processes or design protection. Here we quantitatively characterize damage in near-live human skin after impact by debris-simulating kinetic projectiles at differing impact angles and energies. Impact events are monitored using high-speed and quantitative imaging to visualize skin injuries. These findings are utilized to develop a highly predictive, dynamic computational skin-injury model. Results provide quantitative insights revealing how the dermal-epidermal junction controls more severe wound processes. Findings can illuminate expected wound severity and morbidity risks to inform clinical treatment, and assess effectiveness of emerging personal protective equipment. 

/pdf/characterization-and-modeling-of-partial-thickness-cutaneous-2bv48wo6.pdf

Characterization and modeling of partial-thickness cutaneous injury from debris-simulating kinetic projectiles

Introduction Penetrating wounds from explosively propelled fragments and bullets are the most common causes of combat injury. There is a requirement to assess the potential effectiveness of bullets penetrating human tissues in order to optimise preventive measures and wound trauma management. Methods An advanced voxel model based on the Chinese Visible Human data was built. A digital human vulnerability model was established in combination with wound reconstruction and vulnerability assessment rules, in which wound penetration profiles were obtained by recreating the penetration of projectiles into ballistic gelatin. An effectiveness evaluation method of bullet penetration using the Abbreviated Injury Scale (AIS) was developed and solved using the Monte Carlo sampling method. Results The effectiveness of rifle bullets was demonstrated to increase with increasing velocity in the range of 300–700 m/s. When imparting the same energy, the effectiveness of the 5.56 mm bullet was higher than the 7.62 mm bullet in this model. Conclusions The superimposition of simulant penetration profiles produced from ballistic gelatin simulant has been used to predict wound tracts in damaged tissues. The authors recognise that determining clinical effectiveness based on the AIS scores alone without verification of outcome by review of clinical hospital records means that this technique should be seen more as a manner of comparing the effectiveness of bullets than an injury prediction model.

https://militaryhealth.bmj.com/content/jramc/164/3/172.full.pdf

Assessment of bullet effectiveness based on a human vulnerability model

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Assessment of bullet effectiveness based on a human vulnerability model