[Forensic aspects of gunshot suicides in Germany]. / Gerichtsmedizinische Aspekte suizidaler Schussverletzungen--eine Übersichtsarbeit am Beispiel Deutschlands.

Suicidal gunshot wounds are a common appearance in forensic casework. The main task of the coroner lies in the detection of typical pathomorphological correlates, thus differentiating between homicide, suicide and accident. Apart from characteristic bloodstain patterns on the gun and shooting hand, the localisation of the entrance wound and the position of the weapon, additional details such as family background or medical history are important aspects of forensic investigation. An uncommon choice of weaponry and its unusual morphological manifestation often complicate the examination and reconstruction of such cases. Furthermore, due to social stigmatisation, the possibility of secondary changes by relatives at the crime scene should be considered. In addition to autopsy findings, a careful crime scene investigation and bloodstain pattern analysis, a ballistic reconstruction can be an essential tool to gain knowledge of the shooting distance and position of the gun.

Characteristics of ballistic and blast injuries.

Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.

[Characteristic of injuries inflicted by a blank gunshot].

The analysis of the data published in the special literature indicates that forensic-medical aspects of the injuries inflicted by blank shots fired from a variety of small-arms weapons remain poorly known or virtually unexplored. Despite considerable variability of such injuries, their forensic-medical examination should include three basic components, viz. the proof of the absence of the injurious action of the shot, differential diagnostics of the consequences of injuries attributable to each traumatic factor of the shot, and experimental simulation of the damages to the human body and the clothes taking into account concrete models of the weapons and the blank cartridge.

A civilian perspective on ballistic trauma and gunshot injuries.

BACKGROUND: Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities. METHODS: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed. RESULTS: Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference. CONCLUSION: The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.