Blast tattoos resulting from black powder firearms

Blunderbuss: Ocular and Orbital Injuries Due to Muzzle-Loading Firearms

PURPOSE

Injury to the eye and/or orbital and adnexal structures associated with antiquated muzzle-loading firearms has not, to our knowledge, been characterized with the exception of a single case report.

METHODS

A retrospective chart review of 7 patients treated at Vanderbilt University Medical Center from 2003 to 2017 who sustained traumatic injuries to the ocular and/or orbital structures secondary to the discharge of muzzle-loading firearms. The study was approved by the Vanderbilt Institutional Review Board.

RESULTS

In 6/7 cases, injuries occurred secondary to the muzzle-loading firearm exploding due to dysfunction or misuse. Foreign material deriving from the firearm was retained in 3/7 patients. Initial examination of the orbit and adnexa revealed 5/7 individuals sustaining orbital fractures and 6/7 with facial lacerations (including 2 with eyelid lacerations); none had evidence of a lacrimal duct injury. Three patients suffered globe injuries (1 closed-globe and 2 open-globe). Visual acuity at last follow-up was ≥20/20 in 12/14 eyes examined. Surgical intervention was required in the treatment of 4/7 individuals (including 3/7 requiring intervention for sustained orbital fractures). No individuals were wearing eye protection at the time of injury. All individuals survived their injuries.

CONCLUSIONS

The operation of muzzle-loading firearms poses a unique risk of injury to the operator. The resultant injuries in this case series were primarily due to the explosion of the firearm, which subsequently appear similar to orbital and ocular blast injuries caused by explosive weapons. Orbital injuries and more potentially more devastating ocular injuries may have been prevented by protective eyewear.

Black powder handgun shots-Cases analysis and literature review

Black powder weapons are rarely used in countries where access to firearms is easy. Poland has a fairly restrictive law regarding possession of firearms but under the Weapons and Munitions Act of May 21, 1999, as further amended, the possession of black powder weapons using separate loaded ammunition and manufactured before 1885, or replicas thereof, is legal without a permit. When the amendment was introduced, forensic pathologists anticipated a rush of cases involving such weapons, mainly suicides, but also accidents and homicides, but in our own practice in Lodz over the past 10 years (2010-2019) we have encountered only 7 such cases. Although the number is not particularly high, it does nevertheless account for nearly one-fifth of all gunshot deaths in the area. The aim of this paper is to present a series of deaths involving the use of black powder handguns. In analyzed cases, the victims were mostly men, they were sober, and their manner of death was suicide. As far as age was concerned, no regularity was found. All black powder handgun shots were characteristic enough in comparison with those from conventional firearms that they could be identified easily-the entrance wounds were larger than usual, there was a lot of gunpowder around them and in the wound canal, the bone fractures were extensive. Analysis of the literature and of our own material indicates that easy availability is not the only factor affecting the choice of a weapon; ease of use and reliability are also important.

A Gunpowder Tattoo in a 6-Year-Old Girl

Gunpowder tattoos result from explosion and subsequent traumatic implantation of pigmented granules into varying layers of the skin. This report details the case of a 6-year-old with a gunpowder tattoo on the face.

Foreign Body Granulomas

A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.

Muzzle-loading weapons discharging spherical lead bullets: two case studies and experimental simulation using a skin-soap composite model

In current forensic practice, fatal injuries from black powder guns are rare events. In contact and close-range shots, the intensity of GSR deposition (soot, powder particles) is much greater than that in shots with smokeless powder ammunition. The same applies to any burning effects from the combustion gases. Besides, a wad of felt interposed between the propellant and the lead bullet may enter the wound channel. Apart from these findings seen in close-range shots, another characteristic feature results from the mostly spherical shape of the missiles causing maximum tissue damage at the entrance site. Two fatal injuries inflicted with muzzle-loading weapons are reported. In the first case, suicide was committed with a cal. 11.6 mm miniature cannon by firing a contact shot to the back of the neck. In test shots using black powder (1 and 2 g) as propellant, the mean bullet velocity measured 1 m away from the weapon was 87.11 and 146.85 m/s, respectively, corresponding to a kinetic energy of 32.49 and 92.95 J, respectively. Contact test shots to composite models consisting of ballistic soap covered by pig skin at the entrance site were evaluated by CT and revealed cone-like cavitations along the bullet path as known from spherical missiles and penetration depths up to 25 cm. The second case presented deals with a homicidal close-range shot discharged from a muzzle-loading percussion pistol cal. .44. The skin around the entrance site (root of the nose) was densely covered with blackish soot and powder particles, whereas the eyebrows and eyelashes showed singeing of the hairs. The flattened bullet and the wad had got stuck under the scalp of the occipital region. In both cases, there was a disproportionally large zone of tissue destruction in the initial parts of the wound tracks.

Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks

A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.

Death by black powder revolver: a case report

Deaths resulting from the use of black powder handguns are relatively uncommon compared to other firearms. We report the case of a 48 year-old woman who sustained a lethal gunshot wound to the face from a black powder revolver. Autopsy revealed extensive soot and powder deposition around the entrance wound between the right eye and nose with perforation of the skull and brain. The exit wound also contained evidence of soot. Discussion of this characteristic pattern of discharge deposition from black powder weapons is presented.

Tattoos as risk factors for transfusion-transmitted diseases

BACKGROUND

Several infectious diseases have been found to be associated with tattooing, including some transfusion-transmitted diseases (TTDs). Information on tattooing has been included in screening interviews of prospective blood donors and may be a reason for deferral.

METHODS

Review of articles identified through Medline (and other computerized data bases) using medical subject heading (MeSH) terms and textwords for "tattooing," "transfusion", "hepatitis", "human immunodeficiency virus", "acquired immunodeficiency syndrome", "syphilis", "Chagas disease", "infection", "risk factors", and their combinations.

RESULTS

There is strong evidence for the transmission of hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, and syphilis by tattooing. Tattooing may also transmit the human immunodeficiency virus (HIV), although convincing evidence is still lacking. There is little or no evidence that other TTDs can be transmitted by tattooing. Epidemiologic studies to date have shown a large variation in odds ratio estimates of the association between tattooing and HBV, HCV, and HIV infections.

CONCLUSION

Further studies are required to clarify the risk of tattoos in transmitting infectious diseases through blood transfusions. A reassessment of tattoos as a screening criterion among blood donors is justified.

Use of Q-switched alexandrite laser (755 nm, 100 nsec) for removal of traumatic tattoo of different origins

BACKGROUND AND OBJECTIVES

Q-switched laser systems have been used for removal of tattoo-related carbon, graphite, and other particles. We assessed elimination of traumatic tattoos of different origin with Q-switched alexandrite laser in nine patients.

STUDY DESIGN/MATERIALS AND METHODS

Fluence threshold was determined and a spot test was made. Q-switched alexandrite laser, with a fluence range 4.5-8.0 J/cm(2) (mean, 7.16 +/- 1.18), was used at 4-5-week intervals. Total treatment ranged from 3-12 sessions (mean, 6.1 +/- 3.6 sessions). Double-pulse technique was used in black/black-bluish areas, but single-shot was applied to slate-gray pigment.

RESULTS

More than 95% lightening was achieved in five patients after 5.2 +/- 2.3 sessions, and >75% lightening in six subjects after 6.1 +/- 3.1 sessions of treatment. Blacktop, surgical pen, and gravel tattoos presented a better response than gunpowder/fireworks tattoos (>95% vs. 68.7 +/- 23.9% clearance), or tattoos of unknown origin (>95% vs. 62.5 +/- 53% clearance). Epidermal splattering and pinpoint bleeding were observed in one case. No pigmentary alteration or scarring was seen.

CONCLUSION

The Q-switched alexandrite laser is a useful system for removal of traumatic tattoos of diverse origin. The best response (>95% clearance) was achieved in blacktop, surgical pen, and gravel tattoos, although an acceptable degree of lightening may be obtained in tattoos due to gunpowder or fireworks.

Treatment of traumatic facial tattoos caused by black gunpowder

Injuries and tattooing caused by gunpowder explosions may lead to permanent cosmetic disfigurement when they are not treated properly. One must distinguish between early and late treatment and recognize that early correct treatment prevents the development of many problems for both the doctor and the patient. It is essential to emphasize the importance of adequate dermabrasion of the tattooing, preferably within the first 6 h after injury or at the absolute maximum 72 h. When the injury is too old or the tattoos are too deep the minipunch technique has worked well.

Treatment of traumatic tattoos with various sterile brushes

BACKGROUND

Various types of brushes are efficient for the removal of foreign material accidentally projected into the skin by explosive or abrasive trauma.

OBJECTIVE

To evaluate how different times between injury and treatment influenced esthetic results, we retrospectively evaluated 14 patients subjected to the brushing technique.

METHODS

Two groups were identified. Group I had been treated within 24 hours of injury. In group II debridement had been performed later.

RESULTS

Cosmetic results were strikingly better in group I.

CONCLUSION

Our results demonstrate that debridement of traumatic tattoos should be carried out as soon as possible to achieve favorable cosmetic results.

Analysis of cutaneous foreign bodies

Foreign materials from exogenous sources pose a constant challenge to the diagnostic skills of practicing dermatologists. Depending upon circumstances, radiologic, histologic, and ultrastructural techniques can be of assistance in ascertaining the presence and nature of the substance in question. With technologic advancements, identification of small-sized particles is no longer limited to morphologic study alone. Ultrastructural analytic techniques now permit identification of minute particles or quantities of material in tissues with relative ease. No doubt, further application of currently available and newly evolving analytic systems will expand our limits of detection and enhance our scientific knowledge.