Entrance wound
| Penetrating trauma | |
|---|---|
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| Acute penetrating trauma from a close-range shotgun blast injury to knee. Birdshot pellets are visible in the wound, within the shattered patella. The powder wad from the shotgun shell has been extracted from the wound, and is visible at the upper right of the image. | |
| Classification and external resources | |
| ICD-10 | T14.1 |
Penetrating trauma is an injury that occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out the way it entered, or pass through the tissues and exit from another area. An injury in which an object enters the body or a structure and passes all the way through is called a perforating injury, while penetrating trauma implies that the object does not pass through. Perforating trauma is associated with an entrance wound and an often larger exit wound.
Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually occurring in violent crime or armed combat, penetrating injuries are commonly caused by gunshots and stabbings.
Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. The severity of the injury varies widely depending on the body parts involved, the characteristics of the penetrating object, and the amount of energy transmitted to the tissues. Assessment may involve X-rays or CT scans, and treatment may involve surgery, for example to repair damaged structures or to remove foreign objects. Following penetrating trauma, spinal motion restriction is associated with worse outcomes and therefore its should not be done routinely.
As a missile passes through tissue, it decelerates, dissipating and transferring kinetic energy to the tissues; this is what causes the injury. The velocity of the projectile is a more important factor than its mass in determining how much damage is done; kinetic energy increases with the square of the velocity. In addition to injury caused directly by the object that enters the body, penetrating injuries may be associated with secondary injuries, due for example to a blast injury.
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