Temporary Cavity Effects in Blood Vessel Injury by High Velocity Missiles

Determining the wounding effects of ballistic projectiles to inform future injury models: a systematic review

“…All of these papers pertained to bullets and no evidence was found on explosive fragments. A single paper demonstrated macroscopic large artery damage due to the temporary cavity produced by a bullet27 but the effect was only demonstrated in projectiles of velocities exceeding 1000 m.s −1 as they passed the vessel and was not seen in the concurrent in vivo experiments those authors conducted.…”

“…The resultant area has been described as the concussion zone,12 22 the zone of extravasation2 6 29 and the zone of molecular quake 16. Muscle within this area, in the absence of missile or bone fragmentation, generally only sustains minor injury,14 15 27 30 31 although this was contested by one author 32. Microscopic changes to all of the layers in the arterial wall have been demonstrated in blood vessels27 – 29 33 up to 50 mm from the most lateral aspect of macroscopic tissue damage 34.…”

“…Muscle within this area, in the absence of missile or bone fragmentation, generally only sustains minor injury,14 15 27 30 31 although this was contested by one author 32. Microscopic changes to all of the layers in the arterial wall have been demonstrated in blood vessels27 – 29 33 up to 50 mm from the most lateral aspect of macroscopic tissue damage 34. Although some authors have felt that this microscopic arterial damage has warranted debridement of macroscopically normal sections of the artery lateral to the PWT,27 33 it is generally agreed that there is no correlation between microscopic arterial damage and long term morbidity 28 35…”

“…It was recognised that experimental testing of the effects of the temporary cavity generally used isolated tissues and that it is the method of attachment of these structures to their surroundings that may result in damage from this mechanism, such as tearing the attachment of an artery at a fixed point (eg, its entry into a bony foramen). The temporary cavity clearly has varying injurious effects dependent on tissue type and architecture6 13 22 27 56 and we would therefore encourage the term temporary tissue cavity (TTC) instead of temporary wound cavity to differentiate the effect of this mechanism in tissues rather than simulants.…”

Ballistics reviews: mechanisms of bullet wound trauma

“…The cross-sectional area of this cavity is also equal to the bullet's cross-section at that same point modified by a shape factor derived from the bullet's configuration and the amount of resistance offered to it by tissue [34]. The second is the radial stretching of tissue around the bullet's wound track, which momentarily leaves an empty space called the temporary wound cavity [1,11,26,30,39]. This cavitation effect is caused by high pressures surrounding the projectile that accelerate material away from its path.…”