Ballistic injuries are not only caused during war but also during criminal and domestic violence besides the terrorist activities. The development of standards of treatment of gunshot/shell wounds is closely related to several significant medical discoveries. Ballistics is the science of motion of a projectile through a gun barrel and subsequently through a medium such as air and eventually through a target. The terminal portion of the trajectory, if the target is a living tissue, is what one is concerned about when one speaks of wound ballistics. A bullet striking the tissue produces wounding by several mechanisms. The tissue in the path of the bullet is directly injured by crush. Immediately following the passage of a high velocity projectile through the tissue, kinetic energy is dissipated, in part, by creation of the temporary cavity along the bullet track. The resultant stretching, compressing and shearing of tissue may cause damage several centimeters lateral to the track. As the bullet yaws, tumbles, or deforms, the shape of the temporary cavity is affected. The wound may be penetrating or perforating. Penetrating wounds have a wound of entry only. It is in the penetrating wound that the importance of early x-ray examination and localization of foreign bodies reaches its zenith. The actual wound is covered by sterile gauze and the surrounding skin scrubbed and cleaned with an antiseptic lotion. The missile track, beginning with the wound of entry to the wound of exit is laid open. If the distance between the wound of entry and exit is more than 30 CMS, then the track should be laid open from the wound of entry towards the exit direction for 10 CMS, and from the wound of exit to the wound of entry for a distance of 10 CMS. Only dead skin is excised. Damaged subcutaneous fat is excised. Deep fascia should be incised generously so as to have a full exposure of the injured muscle and bone. Damaged muscle is widely excised and loose broken pieces of bone are removed finally, the wound should be packed with saline/povidone iodine solution soaked gauze and dressing loosely applied. Limbs with large soft tissue injury or with fractures should be immobilized. The dura is closed directly or by temporal fascia graft and the skin closed by a rotation flap to provide cover. Wounds involving joints need closure of synovial membrane along with joint capsule after the joint. After initial resuscitation, of immediate concern is, whether the peritoneum has been breached or not, and does the patient need laparotomy. Gunshot wounds of the chest may be penetrating or perforating. Patient may present with symptoms of respiratory distress or cardiovascular collapse. It is generally accepted that only 15 percent of penetrating chest injuries require open thoracotomy.
