Entrance Wounds

Entrance wounds can be divided into four general categories, dictated by the range
of fire from which the bullet was discharged. Range of fire is an expression used to
describe the distance between the gun’s muzzle and the victim/patient. The different
ranges of fire are: distant or indeterminate range; intermediate or medium range; close
range and contact. The entrance wounds associated with each of the four ranges of fire
categories will have physical characteristics pathognomonic to each category.
Distant or indeterminate entrance wounds
The distant or indeterminate gunshot wound of entrance is one which results
when the weapon is discharged at such a distance that only the bullet makes
contact with the victim’s skin. When the bullet or projectile penetrates the epithelial
tissue, there is friction between the skin and the projectile. This friction results in an
abraded area of tissue which surrounds the entry wound and is know as an abrasion
collar (Figs 1 and 2). In general, with the exception of gunshot wounds on the soles of
the feet and palms of the hands, all handgun gunshot wounds of entrance will have an
associated abrasion collar. The width of the abrasion collar will vary depending on the
caliber of the weapon, the angle of bullet impact and the anatomical site of entrance.
Skin which overlies bone will generally have a narrower abrasion collar than skin
supported by soft tissue. Entrance wounds on the soles and palms are usually slit-like in
appearance. It is important to note that the abrasion collar is not the result of thermal
changes associated with a ‘hot projectile’. The terms abrasion margin, abrasion rim,
abrasion ring and abrasion collar are all used interchangeably.
Figure 1 An abrasion collar is the abraided area of tissue surrounding the
entrance wound created by the bullet when it dents and passes through the
epithelium. The abrasion collar will vary with the angle of impact.

Figure 2 The area of abraided tissue surrounding this gunshot wound of entrance
is the ‘abrasion collar’. Additional appropriate terms would include: abrasion
margin, abrasion rim or abrasion ring.
Intermediate range entrance wounds
‘Tattooing’ is pathognomonic for an intermediate range gunshot wound. Tattooing
is a term used to describe the punctate abrasions observed when epithelial tissue
comes into contact with partially burned or unburned grains of gunpowder. These
punctate abrasions cannot be wiped away and will remain visible on the skin for several
days. Clothing, hair or other intermediate barriers may prevent the powder grains from
making contact with the skin. Though it has been reported, it is rare for tattooing to
occur on the palms of the hands or soles of the feet, because of the thickness of the
epithelium in these areas.
The density of the tattooing will be dictated by: the length of the gun’s barrel, the
muzzle-to-skin distance, the type and amount of gunpowder used and the presence of
intermediate objects. Punctate abrasions from unburned gunpowder have been
reported with distances as close as 1 cm, and as far away as 100 cm (Fig 3A, B).
Figures 3 A, B ‘Tattooing’ is the term used to describe punctate abrasions from
the impacting of unburned grains of gunpowder on epithelial tissue. Tattooinghas
been recorded with distances as close as 1 cm and as far away as 100 cm. The
density of the tattooing will be principally determined by the muzzle to skin
distance but may also be affected by the length of the gun barrel and the type of
gun powder used.
Close Range Wounds
Close range entrance wounds are usually characterized by the presence of a
surface contaminant known as soot (Fig. 4A and Fig. 4B). Soot is the carbonaceous
byproduct of combusted gunpowder and vaporized metals. It is generally associated
with a range of fire of less than 10 cm, but has been reported in wounds inflicted at
distances of up to 20-30 cm. The density of the soot will decrease as the muzzle-to-skin
distance decreases. The concentration of soot is also influenced by the amount and
type of gunpowder used, the gun’s barrel length, the caliber of the ammunition and the
type of weapon used. For close range wounds, the longer the barrel length, the denser
the pattern at a given distance. At a close range of fire, the visibility of tattooing may be
obscured by the presence of soot. Also, at a close range, the unburned grains of
powder may be injected directly into the entrance wound.
The term ‘powder burns’ is one used to describe a thermal injury to the
skin, associated exclusively with the rise of weapons (muzzle loaders and starter
pistols). When black power ignites, it produces a flame and large amounts of white
smoke. The flame sometimes catches the user’s clothing on fire, resulting in powder
burns. Black powder is not used in any commercially available ammunition today. The
expression powder burns should not be used to describe the carbonaceous material
deposited on the skin with entrance wounds inflicted by commercially available
cartridges.
Contact wounds
Contact wounds are wounds which occur when the barrel of the gun is in actual
contact with the clothing or skin of the victim. There are two types of contact
wounds: loose contact and tight. Tight contact wounds occur when the muzzle is
pressed tightly against the skin. All material that is discharged from the barrel, including
soot, gases, incompletely burned gunpowder, metal fragments, and the projectile are
injected into the wound. In a loose contact wound, the contact between the skin and the
muzzle is incomplete, and soot and other residues will be distributed along the surface
of the epithelium.
Figure 4 A, B Close range gunshot wounds are characterized by the presence of
soot. Soot is a carbonaceous material which will deposit on skin or clothingat
distances generally less than 10cm.
When a tight contact wound occurs in an area of thin tissue or tissue overlying
bone, the hot gases of combustion will cause the skin to burn, expand and rip (Fig. 5).
The tears of the skin will appear triangular or stellate in configuration (Fig. 5). These
stellate tears are commonly misinterpreted as exit wounds when the physician is basing
that opinion on the size of the wound alone. The stellate wounds resulting from contact
with the barrel will always be associated with the presence of seared skin and soot (Fig.
6). The stellate tears of exit wounds will lack soot and seared skin. The charred or
seared skin of contact wounds will have the microscopic characteristics of thermally
damaged skin. The injection of gases into the skin may also cause the skin to be
forcibly compressed against the barrel of the gun and may leave a muzzle contusion or
muzzle abrasion surrounding the wound (Fig. 7A, and B).
The size of gunshot wounds of entrance bears no reproducible relationship to the
caliber of the projectile.
Exit Wounds
Exit wounds will assume a variety of shapes and configurations and are not consistently
larger than their corresponding entrance wounds. The exit wound size is dictated
primarily by three variables: the amount of energy possessed by the bullet as it exits the
skin, the bullet size and configuration, and the amount of energy transferred to
underlying tissue,i.e. bone fragments. Exit wounds usually have irregular margins and
will lack the hallmarks of entrance wounds, abrasion collars, soot, and tattooing (Fig. 8A
and B). If the skin of the victim is pressed against or supported by a firm object, as the
projectile exits, the wound may exhibit an asymmetric area of abrasion.
Figure 5 The contact wound will exhibit triangular shaped tears of the skin. These
stellate tears are the result of injection of hot gases beneath the skin. These
gases will cause the skin to rip and tear in this characteristic fashion.
Figure 6 Contact wounds will also exhibit seared wound margins as well as
stellate-shaped tears. This is a contact wound from a 38 caliber revolver.
Figure 7 A, B The injection of gases into the skin will cause the skin to expand
and make forceful contact with the barrel of the gun (A). If there is sufficient gas,
this contact will leave a ‘muzzle contusion’ or ‘muzzle abrasion’ around the
wound. This pattern injury mirrors the end of the barrel (B).
Figures 8 A, B Gunshot wounds of exit generally have irregular wound margins
and will lack the physical evidence associated with entrance wound
includingabrasion collars, soot, seared skin and ‘tattooing’. Exit wounds
associated with handgun ammunition are not consistently larger than the
associated exit wound. These slit-like exit wounds have irregular margins.
This area of abrasion has been described as a ‘false’ abrasion collar and is termed a
‘shored’ exit wound (Fig. 9). This false abrasion collar results when the epithelium is
forced outward and makes contact or is slapped against the supporting structure.
Examples of supporting structures are chair backs, floors, walls, or tight clothing. The
shored exit wound may also be called a ‘supported’ exit wound.
Figure 9 A ‘shored’ exit wound has the appearance of a ‘false’ abrasion collar.
This false abrasion collar results when epithelium is forced outward and makes
contact or is slapped against a supporting structure, i.e. floor, wall or furniture. A
short exit may also be referred as a supported exit wound.
Evidence Collection
Any tissue excised from a gunshot wound margin should be submitted for
microscopic evaluation. This microscopic examination will reveal the presence of
carbonaceous materials, compressed and distorted epithelial cells and thermally
induced collagenous changes in the dermal layer. This information may assist the
practitioner in determining the range of fire or entrance versus exit when the physical
exam is indeterminate. It is imperative that treating physicians recognize the importance
of preserving evidence in the gunshot wound victim. It has been recognized that victims
of gunshot wounds should undergo some degree of forensic evaluation prior to surgical
intervention. It is also necessary that healthcare practitioners recognize, preserve and
collect short-lived evidence and not contaminate or destroy evidence while rendering
care.
The clothing of a gunshot wound victim may yield valuable information about the
range of fire and will aid physicians in their efforts to distinguish entrance from
exit wounds (Fig. 10). Fibers of clothing will deform in the direction of the passing
projectile (Fig. 11). Gunpowder residues and carbonaceous soot will deposit on
clothing, just as they do on skin. Some of these residues are not visible to the naked
eye and require standard forensic laboratory staining techniques to detect the presence
of lead and nitrates (Fig. 12). Some bullets, in particular lead bullets, may deposit a thin
layer of lead residue on clothing as they penetrate; this residue is termed ‘bullet wipe’
(Fig. 13).

Figure 10 Carbonaceous material as well as gunshot residue may be deposited

on victims’ clothingif the handgun is discharged within range of fire of less then 1
m. Some gunshot residue from nitrates and vaporized lead will be invisible to the
naked eye. All clothing should be collected and placed in separate paper
containers for evaluation by the forensic laboratory.
Figure 11 Close examination of fibers may reveal the direction of the passing
projectile.
When collecting articles of clothing from a gunshot wound victim, each article
must be placed in a separate paper bag in order to avoid crosscontamination.
Some jurisdictions may elect to perform a gunshot residue test to determine the
presence of invisible residues on a suspects’ skin. Residues from the primer,
including barium nitrate, antimony sulfide, and lead peroxide may be deposited on the
hands of the individual who fired the weapon. The two methods used to evaluate for
residues are flameless atomic absorption spectral photometry (FAAS), and scanning
microscope-energy dispersive X-ray spectrometry (SEM-EDX). For analysis by FAAS, a
specimen is collected by swabbing the ventral and dorsal surfaces of the hand with a
5% nitric acid solution. For analysis by SEM-EDX, tape is systematically pressed
against the skin and packaged. A second method involves placement of tape on the
hands and examining the material under a scanning electron microscope. The
specificity and sensitivity of these tests have been questioned, as residues may be
spread about the crime scene. These residues may be spread by secondary contact
with a weapon or furniture items, and have been known to result in false positive tests.
Controlled studies involving the transfer of gunshot residues from individuals who fired a
weapon to suspects being handcuffed, have been documented. If a gunshot residue
test is to be performed on a victim, it should be done within the first hour of the
weapon’s discharge to increase the sensitivity of the test.
Figure 12 The forensic laboratory can use tests to detect the presence of
vaporized lead and nitrates. These tests will assist the forensic investigator in
determining the range of fire.
Figure 13 A lead or well-lubricated projectile may leave a ring of lead or lubricant
on clothingas it passes through. This deposition of lubricant or lead is referred to
as ‘bullet wipe’.
The bullet, the bullet jacket and the cartridge are invaluable pieces of forensic
evidence. The forensic firearms examiner may use these items to identify or eliminate a
weapon as the one which was fired. When these items are collected from the living
patient, they should be packaged in a breathable container, a container that allows a
free exchange of outside air. If such an item were placed in a closed plastic container,
mold may form and evidence degrade.
When handling evidence, all metal-to-metal contact should be avoided. The tips of
hemostats should be wrapped in sterile gauze and all evidence placed immediately in
containers for transport (skip the metal basin step). Metal-to-metal contact may destroy
or obliterate critical microscopic marks.
Estimation of Bullet Caliber Using Radiographs
Radiographs taken to assist the treating physician in locating retained projectiles may
also be of evidentiary value. Radiographs will assist the physician in determining the
direction from which projectiles were fired as well as their simple number. Practitioners
should not render opinions as to the caliber of a specific projectile, based upon
radiographic imaging alone, because only radiographs taken exactly 72 in (183 cm)
from the projectile will reveal the projectile’s appropriate size. The bullet size on the
radio-graphic film will increase as the distance between the film and X-ray source
decreases.