- Email: [email protected]
Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report
ARTICLE IN PRESS
YBJOM-4272; No. of Pages 3
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx.e1–xxx.e3
Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report Ben Strong a,∗ , Martin Coady b a b
Trust Registrar, Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK (Corresponding Author) Consultant Plastic Surgeon, Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK
Accepted 20 May 2014
Abstract Airsoft is a recreational combat sport that originated in Japan in the 1970s and is currently increasing in popularity in the UK. Participants use air or electrically powered weapons to fire small plastic pellets at a controlled pressure. UK law strictly regulates the maximum muzzle velocity and the type of ammunition used in these weapons. A search of published papers found several reports of penetrating ocular injuries caused by Airsoft pellets, but no reports of penetrating injuries to other areas of the body. We report the case of a 25-year-old man who sustained a penetrating injury to the cheek after being shot with an Airsoft weapon. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Airsoft; Trauma; Soft Tissue; Pellet; Air Weapons; Air Gun
Introduction Airsoft is a combat sport similar to paintballing in which participants engage in battles using replica weapons. The games are usually held in purposely constructed areas where members of the public can pay to engage in team-based “skirmishes”.1 Currently, over 200 centres in the UK offer Airsoft gaming, and more than 50 retailers sell Airsoft guns and ammunition.2 The guns differ from standard BB guns as they use lightweight (0.2 g) 6 mm diameter biodegradable plastic balls as ammunition instead of 4.5 mm metal balls.1 Most UK centres limit the muzzle velocity of the guns to 328 feet/second (fps),3 which is considered adequate to ensure that weapons do not cause more than
∗ Corresponding author. Department of Plastic Surgery, Ward 35, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW. E-mail address: ben [email protected] (B. Strong).
trivial injury (not capable of penetrating the skin). Consequently, they are not regulated as firearms or airguns under UK law.4 Case report A 25-year-old man was referred by a local walk-in centre after he was shot during an Airsoft game. He presented to our trauma clinic about 20 hours after injury. He complained of pain and tenderness over the inferior aspect of his left cheek overlying the risorius muscle. He had no important past medical history, and specifically no history of a connective tissue disorder or use of topical steroids. He had been shot at a range of several metres. Clinical examination showed an area of erythema about 1 cm in diameter, with no obvious entry wound (Fig. 1). A small, firm mass underlying the area was palpable. There was no neurological or functional deficit. Radiological assessment was deemed unlikely to be of benefit.
http://dx.doi.org/10.1016/j.bjoms.2014.05.007 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Strong B, Coady M. Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.05.007
YBJOM-4272; No. of Pages 3
xxx.e2
ARTICLE IN PRESS
B. Strong, M. Coady / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx.e1–xxx.e3
Fig. 1. Patient’s face showing entry wound before operation.
Fig. 2. Removed pellet.
The area was marked with surgical pen, and 5 ml of 1% lidocaine with 1:200 000 adrenaline was injected around it. The skin was prepared with aqueous chlorhexidine solution, and a linear incision made over the centre of the mark. The superficial fascia was disrupted centrally, and there was a 6 mm diameter, white, spherical foreign body lying 5 mm beneath. It was easily extracted intact (Fig. 2). No further damage to underlying structures was apparent. Surrounding tissue appeared healthy, and there was no need for substantial debridement. The cavity was washed out with aqueous chlorhexidine and 0.9% sodium chloride, and closed with intradermal 5-0 polydioxanone (PDSTM , Ethicon) and subcuticular 6-0 poliglecaprone 25 sutures (Monocryl® , Ethicon). Postoperative healing was uncomplicated. No postoperative antibiotics were given.
Airsoft pellets weigh only 0.2 g, although they are slightly larger than the projectiles that were used.6 In a study using pig eyeballs, Marshall et al found that a 6 mm plastic Airsoft pellet had the capacity to penetrate at a velocity of 325 fps,7 and concluded that their capacity for injury is similar to that of a 4.5 mm steel BB pellet. It is known that the properties of human skin vary considerably with age and body site in thickness, elasticity, laxity, and energy absorption.8 The studies quoted above, while forming a basis for health and safety law, do not rule out the possibility of a penetrating skin injury at lower projectile velocities. Our case highlights the need to be aware of penetrating injuries caused by Airsoft weapons, and the potential requirement for surgical exploration and removal of retained foreign bodies.
Discussion
References
Non-powder projectiles fired from weapons such as Airsoft guns cause injuries primarily by direct crushing and laceration. Secondary damage caused by elastic deformation is not serious in this type of injury, as the projectile weighs very little and loses velocity quickly on contact with the tissue.5 DiMaio et al found that a 4.5 mm steel BB pellet weighing around 0.5 g required an entry velocity of 331 fps to penetrate the skin of a human lower limb, while larger and heavier projectiles penetrate at a much lower velocity.6
1. Gun Ho Airsoft. Available from URL: http://www.gunhoairsoft.co.uk 2. Airbana Airsoft Map. Available from URL: http://www.airsoftmap.net 3. The United Kingdom Airsoft Sites Governing Body. UKASGB guidelines. Available from URL: http://www.swatairsoft.eu/resources/ ukasgb guidelines v3.pdf 4. Guide on firearms licensing law. Home Office, 2013. Available from URL: www.gov.uk/government/uploads/system/uploads/attachment data/file/ 262215/Guidance on Firearms Licensing Law v6 Nov 2013.pdf 5. Bligh-Glover WZ. One-in-a-million shot: a homicidal thoracic air rifle wound, a case report, and a review of the literature. Am J Forensic Med Pathol 2012;33:98–101.
Please cite this article in press as: Strong B, Coady M. Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.05.007
YBJOM-4272; No. of Pages 3
ARTICLE IN PRESS
B. Strong, M. Coady / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx.e1–xxx.e3 6. DiMaio VJ, Copeland AR, Besant-Matthews PE, Fletcher LA, Jones A. Minimal velocities necessary for perforation of skin by air gun pellets and bullets. J Forensic Sci 1982;27:894–8. 7. Marshall JW, Dahlstrom DB, Powley KD. Minimum velocity necessary for nonconventional projectiles to penetrate the eye: an experimental
xxx.e3
study using pig eyes. Am J Forensic Med Pathol 2011;32: 100–3. 8. Smalls LK, Randall Wickett R, Visscher MO. Effect of dermal thickness, tissue composition, and body site on skin biomechanical properties. Skin Res Technol 2006;12:43–9.
Please cite this article in press as: Strong B, Coady M. Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.05.007
YBJOM-4272; No. of Pages 3
Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx.e1–xxx.e3
Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report Ben Strong a,∗ , Martin Coady b a b
Trust Registrar, Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK (Corresponding Author) Consultant Plastic Surgeon, Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK
Accepted 20 May 2014
Abstract Airsoft is a recreational combat sport that originated in Japan in the 1970s and is currently increasing in popularity in the UK. Participants use air or electrically powered weapons to fire small plastic pellets at a controlled pressure. UK law strictly regulates the maximum muzzle velocity and the type of ammunition used in these weapons. A search of published papers found several reports of penetrating ocular injuries caused by Airsoft pellets, but no reports of penetrating injuries to other areas of the body. We report the case of a 25-year-old man who sustained a penetrating injury to the cheek after being shot with an Airsoft weapon. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Airsoft; Trauma; Soft Tissue; Pellet; Air Weapons; Air Gun
Introduction Airsoft is a combat sport similar to paintballing in which participants engage in battles using replica weapons. The games are usually held in purposely constructed areas where members of the public can pay to engage in team-based “skirmishes”.1 Currently, over 200 centres in the UK offer Airsoft gaming, and more than 50 retailers sell Airsoft guns and ammunition.2 The guns differ from standard BB guns as they use lightweight (0.2 g) 6 mm diameter biodegradable plastic balls as ammunition instead of 4.5 mm metal balls.1 Most UK centres limit the muzzle velocity of the guns to 328 feet/second (fps),3 which is considered adequate to ensure that weapons do not cause more than
∗ Corresponding author. Department of Plastic Surgery, Ward 35, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW. E-mail address: ben [email protected] (B. Strong).
trivial injury (not capable of penetrating the skin). Consequently, they are not regulated as firearms or airguns under UK law.4 Case report A 25-year-old man was referred by a local walk-in centre after he was shot during an Airsoft game. He presented to our trauma clinic about 20 hours after injury. He complained of pain and tenderness over the inferior aspect of his left cheek overlying the risorius muscle. He had no important past medical history, and specifically no history of a connective tissue disorder or use of topical steroids. He had been shot at a range of several metres. Clinical examination showed an area of erythema about 1 cm in diameter, with no obvious entry wound (Fig. 1). A small, firm mass underlying the area was palpable. There was no neurological or functional deficit. Radiological assessment was deemed unlikely to be of benefit.
http://dx.doi.org/10.1016/j.bjoms.2014.05.007 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Strong B, Coady M. Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.05.007
YBJOM-4272; No. of Pages 3
xxx.e2
ARTICLE IN PRESS
B. Strong, M. Coady / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx.e1–xxx.e3
Fig. 1. Patient’s face showing entry wound before operation.
Fig. 2. Removed pellet.
The area was marked with surgical pen, and 5 ml of 1% lidocaine with 1:200 000 adrenaline was injected around it. The skin was prepared with aqueous chlorhexidine solution, and a linear incision made over the centre of the mark. The superficial fascia was disrupted centrally, and there was a 6 mm diameter, white, spherical foreign body lying 5 mm beneath. It was easily extracted intact (Fig. 2). No further damage to underlying structures was apparent. Surrounding tissue appeared healthy, and there was no need for substantial debridement. The cavity was washed out with aqueous chlorhexidine and 0.9% sodium chloride, and closed with intradermal 5-0 polydioxanone (PDSTM , Ethicon) and subcuticular 6-0 poliglecaprone 25 sutures (Monocryl® , Ethicon). Postoperative healing was uncomplicated. No postoperative antibiotics were given.
Airsoft pellets weigh only 0.2 g, although they are slightly larger than the projectiles that were used.6 In a study using pig eyeballs, Marshall et al found that a 6 mm plastic Airsoft pellet had the capacity to penetrate at a velocity of 325 fps,7 and concluded that their capacity for injury is similar to that of a 4.5 mm steel BB pellet. It is known that the properties of human skin vary considerably with age and body site in thickness, elasticity, laxity, and energy absorption.8 The studies quoted above, while forming a basis for health and safety law, do not rule out the possibility of a penetrating skin injury at lower projectile velocities. Our case highlights the need to be aware of penetrating injuries caused by Airsoft weapons, and the potential requirement for surgical exploration and removal of retained foreign bodies.
Discussion
References
Non-powder projectiles fired from weapons such as Airsoft guns cause injuries primarily by direct crushing and laceration. Secondary damage caused by elastic deformation is not serious in this type of injury, as the projectile weighs very little and loses velocity quickly on contact with the tissue.5 DiMaio et al found that a 4.5 mm steel BB pellet weighing around 0.5 g required an entry velocity of 331 fps to penetrate the skin of a human lower limb, while larger and heavier projectiles penetrate at a much lower velocity.6
1. Gun Ho Airsoft. Available from URL: http://www.gunhoairsoft.co.uk 2. Airbana Airsoft Map. Available from URL: http://www.airsoftmap.net 3. The United Kingdom Airsoft Sites Governing Body. UKASGB guidelines. Available from URL: http://www.swatairsoft.eu/resources/ ukasgb guidelines v3.pdf 4. Guide on firearms licensing law. Home Office, 2013. Available from URL: www.gov.uk/government/uploads/system/uploads/attachment data/file/ 262215/Guidance on Firearms Licensing Law v6 Nov 2013.pdf 5. Bligh-Glover WZ. One-in-a-million shot: a homicidal thoracic air rifle wound, a case report, and a review of the literature. Am J Forensic Med Pathol 2012;33:98–101.
Please cite this article in press as: Strong B, Coady M. Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.05.007
YBJOM-4272; No. of Pages 3
ARTICLE IN PRESS
B. Strong, M. Coady / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx.e1–xxx.e3 6. DiMaio VJ, Copeland AR, Besant-Matthews PE, Fletcher LA, Jones A. Minimal velocities necessary for perforation of skin by air gun pellets and bullets. J Forensic Sci 1982;27:894–8. 7. Marshall JW, Dahlstrom DB, Powley KD. Minimum velocity necessary for nonconventional projectiles to penetrate the eye: an experimental
xxx.e3
study using pig eyes. Am J Forensic Med Pathol 2011;32: 100–3. 8. Smalls LK, Randall Wickett R, Visscher MO. Effect of dermal thickness, tissue composition, and body site on skin biomechanical properties. Skin Res Technol 2006;12:43–9.
Please cite this article in press as: Strong B, Coady M. Penetrating Facial Injury with an “Airsoft” Pellet: A Case Report. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.05.007