Soft Tissue Ballistic Wound Management Algorithm of Bellamy and Zajtchuk

Findings in Sequence

Management

Is there evidence of wound sepsis, with purulent drainage, swelling, heat, tenderness, erythema?

incision and drainage;

debidement as needed;

fasciotomy as needed

antibiotic therapy

Does the wound need to be explored because of its location or the presence of neurovascular and/or bone injury?

exploration with repair;

debridement as needed

Is there evidence of (a) a large permanent cavity or projectile fragments on ultrasound or X-ray examination, or (b) obvious bleeding, ecchymosis, pain and swelling or (c) multiple confluent wounds?

debridement

All other wounds

nonoperative management with effective antibiotic prophylaxis