Open wound drainage versus wound excision in treating the modern assault rifle wound

Abstract

Military dogma of the past 20 years preaches that excision of all injured tissue around the path of a penetrating projectile is essential in wound treatment. To find out whether excising injured muscle surrounding a bullet path benefits healing over and above the benefit provided by a simple release of tension by incision, two groups of 90 kg swine were shot in the hind leg with a replica of the AK-74 assault rifle projectile. One group was treated by excision of injured tissue around the projectile path; in the other group no tissue was excised. Both groups were given parenteral penicillin for 5 days, and simple gauze dressings were used to cover the wounds. No difference in healing time occurred; the wounds in both groups had closed, and no epithelial defect remained by 20 to 22 days. These results indicate that the simple extremity wound caused by the modern-generation assault rifle, provided with adequate open drainage and systemic penicillin, heals as rapidly when the body defense mechanisms handle the disrupted tissue as when an attempt is made to excise it surgically.