Gunshot injuries are challenging conditions because of the unique characteristics of the wounding agents producing soft tissue damage that may be compounded by the formation of an expanding temporary cavity (cavitation). Variations in ballistic performance leading to higher energy transfer by the projectile, including bullet tumbling, deformation, and fragmentation, cause increased soft tissue injury and may also lead to more extensive bone comminution compromising local blood supply. Once life-threatening injuries have been excluded or properly addressed, the emergency management of localized trauma from bullets and shotgun pellets may be complicated due to progressive tissue necrosis within the zone of injury. Additionally, the risk of infection should be tackled, especially in high energy bone injuries. War experience suggests a baseline separation between wounds with limited tissue destruction which can routinely be managed as simple penetrating injuries and those resulting from high energy transfer to the tissues involving a substantial amount of necrotic elements surrounding the wound channel which call for a more aggressive surgical approach. A further justification for such a distinction is the need for antibiotic therapy, which varies according to most studies depending on the wounding mechanism, the nature of the wound, and the extent of tissue injury. The emergency physician should also be aware of the possibility of “bizarre” bullet paths resulting in occult injuries of important anatomic structures.

Homemade guns may inflict serious injuries mainly depending on the shooting distance. A case of a male victim discovered dead with a head wound thought to be inflicted by a homemade gun firing modified ammunition is presented. Upon completion of the postmortem examination, the question of whether the homemade gun recovered on site was able to inflict such a wound arose. An experimental approach was employed to evaluate the ballistic characteristics and wounding pattern of the homemade gun and then compare it with the actual case. Ballistic gelatin with an incorporated bone simulant was used to model and approximate the behavior of the projectile when striking and penetrating the victim’s head. The retention of the bullets’ path in gelatin was verified through experimental shootings using the same homemade gun and similar type of projectiles. Analysis of the experimental shootings allowed for improved observation and documentation of the wounding pattern, thus confirming the initial hypothesis that the recovered homemade gun did in fact inflict the wound observed during the autopsy of the victim.

Gunshot injuries are challenging conditions because of the unique characteristics of the wounding agents producing soft tissue damage that may be compounded by the formation of an expanding temporary cavity (cavitation). Variations in the ballistic performance leading to higher energy transfer by the projectile, including bullet tumbling, deformation and fragmentation, cause increased soft tissue injury and may also lead to more extensive bone comminution compromising local blood supply. Once life-threatening injuries have been excluded or properly addressed, the emergency management of localized trauma from bullets and shotgun pellets may be complicated due to progressive tissue necrosis within the zone of injury. Additionally, the risk of infection should be tackled especially in high energy bone injuries. War experience suggests a baseline separation between wounds with limited tissue destruction which can routinely be managed as simple penetrating injuries and those resulting from high energy transfer to the tissues involving a substantial amount of necrotic elements surrounding the wound channel which call for a more aggressive surgical approach. A further justification for such a distinction is the need for antibiotic therapy, which varies according to most studies depending on the wounding mechanism, the nature of the wound and the extent of tissue injury. The emergency physician should also be aware of the possibility of “bizarre” bullet paths resulting in occult injuries of important anatomic structures.

In wound ballistics research there is a relationship between the data that characterize a bullet and the injury resulted after shooting when it perforates the human body. The bullet path in the human body following skin perforation as well as the damaging effect cannot always be predictable as they depend on various factors such as the bullet's characteristics (velocity, distance, type of firearm and so on) and the tissue types that the bullet passes through. The purpose of this presentation is to highlight the contribution of Computed Tomography (CT) in wound ballistics research. Using CT technology and studying virtual "slices" of specific areas on scanned human bodies, allows the evaluation of density and thickness of the skin, the subcutaneous tissue, the muscles, the vital organs and the bones. Density data taken from Hounsfield units can be converted in g/ml by using the appropriate software. By evaluating the results of this study, the anatomy of the human body utilizing ballistic gel will be reproduced in order to simulate the path that a bullet follows. The biophysical analysis in wound ballistics provides another application of CT technology, which is commonly used for diagnostic and therapeutic purposes in various medical disciplines.