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December 9, 1988

Wound Ballistics

Author Affiliations

San Antonio, Tex

San Antonio, Tex

JAMA. 1988;260(22):3278. doi:10.1001/jama.1988.03410220061024

To the Editor. —  In his recent review, Dr Fackler1 suggests that current treatment of missile wounds is inappropriate as a result of what he terms misconceptions, half-truths, and misinterpretation of wound ballistics studies. As beauty is in the eye of the beholder, misinterpretation appears to be in the mind of the reader, since it would be difficult for most to interpret the recommendations of the various authors cited as favoring débridement of excessive amounts of viable tissue.2,3 Dr Fackler appears to confuse the results of laboratory studies with clinical practice. Experienced surgeons do not débride cavities of any sort—they excise tissue that appears to be dead and preserve viable tissue.In the absence of specific data, Dr Fackler suggests that the lower incidence of clostridial myositis in conflicts since World War I correlates with increased antibiotic use, but it also correlates with increased understanding of wound ballistics,