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Perforation of fragment simulating projectiles into goat skin and muscle

Article in Journal of the Royal Army Medical Corps · June 2013

DOI: 10.1136/jramc-2013-000065 · Source: PubMed

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Original paper
1
Academic Department of
Military Surgery and Trauma,
Royal Centre for Defence
Medicine, Royal Centre for
Defence Medicine, Birmingham
Research Park, Birmingham,
UK
2
Department of Injury
Modelling, Dstl Porton Down,
Salisbury, Wiltshire, UK
Correspondence to
Major John Breeze, Academic
Department of Military Surgery
and Trauma, Royal Centre
for Defence Medicine,
Birmingham Research Park,
Birmingham B15 2SQ, UK;
jbreeze@dstl.gov.uk
Received 11 March 2013
Accepted 12 March 2013
To cite: Breeze J,
James GR, Hepper AE. J R
Army Med Corps
2013;159:84–89.
84
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Perforation of fragment simulating projectiles
into goat skin and muscle
Johno Breeze,1,2 G R James,2 A E Hepper2
ABSTRACT
Introduction Ballistic gelatin is the most common tissue
simulant used to reproduce the penetration of projectiles
into muscle but published data to support its use are pri-
marily based on bullets, despite explosive fragments being
the most common cause of injury to soldiers on current
operational deployments. Published ballistic tests using
animal and artificial skin and muscle tissue surrogates also
lack standardisation in methodology such that limited com-
parisons with that of human tissues can currently be made.
Method Three masses of cylindrical NATO standardised
fragment simulating projectiles (FSPs) were fired at 20% bal-
listic gelatin and the hind thighs of a killed goat. Threshold
(Vth) and V50 velocities required for skin perforation and
depth of penetration (DoP) into muscle were compared with
gelatin. The intercept and gradient of the linear regression
lines for DoP versus velocity were compared between gelatin
and goat with significance defined as p<0.05.
Results V50 goat skin perforation velocities for the 0.16,
0.49 and 1.10 g FSPs were 121.1, 103.7 and 97.8 m/s,
respectively. There was a significant difference in the V50
required to perforate the gelatin surface compared with goat
skin for the 0.16 and 0.49 g FSPs but not the 1.10 g. There
was no statistical difference in the gradients for DoP versus
velocity between animal and gelatin for either the 0.16 or
1.10 g FSPs.
Discussion This study has produced data for skin perfor-
ation velocities and generated algorithms describing velocity
versus predicted DoP into muscle for three standardised pro-
jectiles, which will be used to improve the fidelity of future
injury models. 20% gelatin was demonstrated to accurately
reproduce the retardation of the 1.10 g FSPs into goat
muscle but the addition of a skin simulant will be required
to accurately predict DoP for FSPs less than 1.10 g.
INTRODUCTION
Improvised explosive devices (IEDs) remain the most
common cause of injury to UK service personnel in
the current military environment;1 however, the
majority of research into the penetration of human
tissues by ballistic projectiles has focused on bullets.2 3
Fragments from IEDs are more commonly irregular
in shape, increasing their drag coefficient in air in
comparison with more regularly shaped missiles such
as spheres.2 Therefore, although the initial velocities
of such fragments are usually in the region of 1000–
1500 m/s, it is believed that most injuries are from
fragments with velocities of less than 500 m/s at the
time of impact.4
Physical models remain an essential tool in predict-
ing the effects of ballistic injury and enable compari-
sons of potential mitigative systems to be made.
However, the shapes, sizes and consistency of frag-
ments produced in explosions are not always easy to
Breeze J, et al. J R Army Med Corps 2013;159:84–89. doi:10.1136/jramc-2013-000065
Key messages
▸ Physical models remain an essential tool in
predicting the effects of ballistic injury.
▸ Ballistic gelatin is the most common tissue
simulant used to reproduce the penetration of
projectiles into muscle.
▸ Published data validating gelatin are primarily
based on bullets, despite explosive fragments
being the most common cause of injury to
soldiers on current operational deployments.
▸ Existing data testing fragment simulating
projectiles (FSPs) into animal tissue and
simulants are of limited value due to poor
descriptions of methodology and lack
standardisation.
▸ The retardation of a NATO standardised cylindrical
1.10 g FSP into goat muscle was shown to be
accurately reproduced by 20% gelatin.
▸ A skin simulant will be required to accurately
predict retardation of cylindrical FSPs less than
1.10 g.
quantify. Analysis of fragments produced by common
explosive weaponry in conjunction with those frag-
ments removed from injured service personnel will
give some indication of representative fragments.
In an attempt to standardise ballistic fragment testing
between countries, a North Atlantic Treaty
Organization (NATO) Standardising Agreement
(STANAG) was published in 2003 describing reprodu-
cible fragment simulating projectiles (FSPs) of fixed
dimensions, masses and shapes.4 Most previous experi-
ments using FSPs have used spheres5 due to their
greater reproducibility despite the recognition that
cylinders are generally more representative of IEDs.2 6 7
Our knowledge of the resistance of human tissues
to explosive fragments is based upon tests on post-
mortem human subject (PMHS), animal and physical
models. PMHS literature has focused more on the
ballistic properties of skin rather than muscle.
However, the age range of PMHS is typically older
than the population of interest when developing
Personal Protective Equipment (PPE) (usually healthy
young men). Multiple authors5 8–10 have published
equations based on PMHS studies to predict the vel-
ocity required for differing sizes of bullets and air rifle
pellets to penetrate and perforate skin. These equa-
tions differ from one another primarily because they
are based on a very small data set and use different
methods to determine skin perforation. Some papers
use threshold velocity (Vth) (the minimum velocity in
that experiment which resulted in skin perforation)
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Original paper

particularly in the modelling of human skin. The choice of

Figure 1 Mattoo’s suggested empirical relationship8 relating Vth
(threshold velocity, m/s) for skin perforation versus projectile sectional
density (S=mass over presented area, g/cm2).
whereas other papers use V50 velocity (the velocity at which 50%
of projectiles perforate skin). Other inconsistencies include a lack
of description of what is actually meant by skin perforation as well
as inadequate descriptions of the dimensions and masses of the
projectiles used. For example, in the UK skin ‘perforation’ means
that the projectile has passed through all layers of skin, but the
term ‘penetration’ is used to describe this in the USA. Sectional
density (the mass over cross sectional area) of the projectile is a way
of standardising projectile characteristics; it has been shown to be a
good predictor for skin perforation and is believed to account for
all projectile geometries, sizes and densities.8 11 Jussila et al11 felt
that Mattoo’s8 suggested empirical relationship between Vth for
skin perforation versus projectile sectional density (Figure 1) was
the best fit for the limited existing evidence.
Artificial substitutes for skin and muscle have been sought to
allow greater reproducibility between testing and to alleviate the
need for PMHS and animal testing. Gelatin is generally accepted
as a good substitute for modelling animal muscle.5 12–14 In turn,
it is widely accepted that animal muscle is a good analogy for
human muscle, despite no direct comparisons ever having been
published in the open literature.2 5 Although missile tracks in
gelatin blocks are not direct indicators of the amount of tissue
damaged by penetrating projectiles, gelatin does simulate the
average tissue response in terms of projectile penetration depth
and relating temporary cavity volume to energy deposition.4
Despite considerable research,11 no practical artificial skin simu-
lant has been found, generally relating to the difficulties in the
consistent reproducible production of the proposed materials.5
Due to the scarcity of appropriate PMHS in conjunction with
limitations in the ballistic properties of artificial substitutes,
there has been an intermittent need for animal surrogates,
animal appears to have been limited to that of goats, pigs and
dogs.5 Dogs are believed to be a poor substitute in modelling
ballistic trauma in humans3 and the few published results in the
literature lack conformity due to the great variation in skin
properties between breeds.15 Porcine muscle is believed to be a
good analogy of human muscle for ballistic testing;5 13 16
however, the published evidence consists of a single paper,4
which showed good correlation between pig muscle and 20%
gelatin at higher velocities but poor correlation at lower ones
(<500 m/s). Pig skin is coarser and thicker than human skin,17
reflecting significantly different biomechanical properties, espe-
cially in terms of elasticity and tensile strength due to the
greater density of collagen fibres;17 it is therefore accepted to be
a poor substitute for human skin in terms of ballistic testing.5 18
Goat skin has been the most traditional animal surrogate for
modelling the penetrating effects of ballistic impacts into human
skin10 19 20 due to perceived similarities in biomechanical prop-
erties.5 10 20 21 Goat skin has the same three layers as human
skin, namely epidermis, dermis and subcutaneous tissue22 23 and
also varies in thickness in different body areas, being deepest on
the dorsal aspects.24 The thigh is the body area that has trad-
itionally been used for ballistic penetration testing, most likely
because it represents a large surface area to increase the number
of available shots and has a large proportion of muscle. The
thickness of human thigh skin has been described as being
between 1.5 and 1.9 mm,25 26 thinner than the 3–4 mm
described in ballistic experiments on goats.10 20 However, the
measurements on goat skin used that separated from the under-
lying muscle and therefore it is unclear if these measurements
represent true thickness in vivo.
A systematic literature review including MEDLINE, Google
Scholar, Scopus and the Web of Science prior to the start of our
experimentation found two pertinent papers in peer-reviewed
journals10 21 and three open-access reports20 27 28 (Table 1) per-
taining to ballistic penetration of goat skin and/or muscle. In
addition, a single historical document was also identified in the
newly available declassified documents in the archives of our
institution.29 Existing published ballistic experimentation using
goats usually pertain to the surgical management of ballistic

Table 1 Previous published ballistic testing using goats

Lead author and
year of
publication Surrogate
29
Hall 1937 Goat skin with underlying
muscle
Krauss 196028 Goat skin with underlying
muscle
Light 196321 Goat skin with underlying
muscle
Kokinakis 196520 Isolated goat skin
Sperrazza 196810 Isolated goat skin of
average thickness 3 mm
Lewis 197827 Isolated goat skin (average
thickness 4 mm) lying on
ballistic gelatin
DoP, depth of penetration.
Projectile Pertinent results to our study Notes
Two 0.14 g metal DoP through skin and muscle was 52 and Composition of metal not stated. Shape not
fragments 55 mm at 610 m/s stated. Skin penetration threshold not stated
18 g spheres Skin remained intact at 45.7 m/s but was Composition and dimensions of spheres
broken at 66.4 m/s unknown. Unclear if penetration or perforation
Steel spheres of masses 0.49 g sphere penetrated 190–400 mm Analysed DoP for muscle only. Did not measure
0.44, 1.04, 3.59 and muscle at 488–1024 m/s. 1.04 g sphere skin penetration. Did not state which body area
5.49 g penetrated 180–600 mm muscle at 524– each shot fired at but mostly at chest
1005 m/s
Steel cubes of 0.14 and Threshold velocity for skin penetration/ Unclear if perforation or penetration. No DoP
1.06 g, and a steel perforation was 94.5 m/s for 0.14 g cube and into goat muscle stated. Unclear if velocity
sphere of 0.06 g 62.8 m/s for 1.06 g cube measured was V50
Steel spheres of masses Threshold velocity for skin perforation was Measured skin perforation (using V50) No DoP
1.0, 2.0 and 10.0 g 60 m/s for 1.0 g steel sphere into muscle measured. Proposed equation to
predict skin penetration
0.26, 1.0, 4.1 g steel Threshold velocity for skin perforation was Measured skin perforation (using V50). No DoP
cubes and 0.06 g steel 62.7 m/s for 1.0 g cube into muscle measured
sphere

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Original paper
injury3 and no histopathological data exist regarding its suitabil-
ity in terms retardation of projectiles. These papers demon-
strated a lack of conformity in definitions of penetration,
methodology and projectile description such that clear compari-
sons cannot be made between one another or PMHS data. The
aim of this study was to determine the velocity of skin perfor-
ation and depth of penetration (DoP) into muscle of three inter-
nationally standardised FSPs into intact goat thighs using a
clearly described methodology.
METHOD
Three masses of FSP (0.16, 0.49 and 1.10 g) were chosen in
accordance with the NATO STANAG.15 The 0.16 and 0.49 g
FSPs were standard cylinders and the 1.1 g a chisel-nosed cylin-
der (Figure 2). The chisel-nosed cylindrical 1.10 g FSP has been
the standard projectile for the appraisal of body armour and
helmets to date.2 10 20 21 30 The 0.16 g FSP was the closest size
to that used by Bowyer and colleagues,4 Kokinakis and
Sperrazza20 and Sperrazza and Kokinakis10 and is believed to be
representative of the most common size of preformed fragment-
ing munition.10 20 31 32 A third fragment size was chosen half
way between the two (0.49 g) on the STANAG sizing and was
similar to the 0.54 g chosen by Jussila et al11 and 0.44 g used
by Light.21
Gelatin was prepared using the following standardised
method used throughout our institution. Type A ballistic grade
(250 bloom, 20% by mass) dry gelatin powder was mixed with
distilled water at 70°C±5°C. The water was stirred while the
gelatin flakes were added slowly. When all the gelatin was
added, it was stirred for an additional 5 min. It was then
covered and allowed to stand for 5 min. After this, it was stirred
once more for 5 min, and then allowed to stand for a further
45 min. Any excess foam that had formed on the surface of the
gelatin was scraped off and the liquid gelatin decanted into
moulds. Following cooling to 20°C, the gelatin block was
removed from the mould (dimensions 45 cm×20 cm×20 cm)
and stored at a temperature of 10°C±2°C for 8–12 h.
The goat used was a 4-year-old Saanen breed (Capra hircus)
weighing approximately 60 kg. Ethical approval had been
obtained from the Ministry of Defence Research and Ethics
Committee. The animal was killed humanely using a Schedule 1
method and had its hind legs clipped to remove any hair in
accordance with previous experiments.9 Ballistic testing started
within 15 min of the animal being killed. Each leg was elevated
in turn using rope until the leg was taut (but not tight) and
shots aimed at the thigh to provide comparisons with previous
experiments.10
Figure 2 A 1.10 g chisel-nosed
cylindrical fragment simulating
projectile: dimensions derived from
those specified in the NATO
Standardising Agreement.15
86
The animal or gelatin blocks were placed in front of a firing
rig, with a 5 m distance between the end of the barrel and the
target. FSPs were fired from a Pressure Housing weapon system,
with a separate smooth bore barrel for each different diameter
projectile. The projectiles were propelled using rechargeable
37 mm compressed air cartridges, using pressures of 3–20 MPa.
Velocity was measured using solid state velocity equipment with
a 1 m separation between the velocity heads. The V50
(the velocity at which 50% of projectiles perforate skin) was
determined to represent the most mathematically accurate and
reproducible method of describing perforation and allowed
comparison with results by Sperrazza and Kokinakis10 and
Lewis et al.27 The Dstl Critical Perforation Analysis tool is a
graphical user interface based on the statistical software package
‘R’.33 This software uses probit analysis to calculate both a V50
velocity and a 95% CI for that V50 velocity. It also was used
during the trial to show when the 95% CI was sufficiently small
to give an accurate and reliable result, at which point the testing
with that fragment was stopped. Perforation was determined by
a military surgeon and was defined as an FSP that traversed
through all the three layers of skin (epidermis, dermis, subcuta-
neous tissue), but did not cause underlying muscle damage.
Non-perforation was classed as anything less than full perfor-
ation of the skin such as the FSP bouncing off skin or penetrat-
ing a partial thickness of skin without breaking the posterior
surface of the skin. Although statistically weaker, the Vth (the
minimum velocity in which perforation occurred) was also cal-
culated to allow comparison with Mattoo’s paper.8
Shots were fired at the lateral thigh surface of all four limbs
and filmed using high-speed video to ascertain if tumbling of
the FSP occurred prior to impact. Due to the front legs being
smaller than the rear, less shots were fired into the former
(approximately 7–10 shots in each leg) than the latter (approxi-
mately 10–15 shots in each leg). A laser targeting device
attached to the rifle barrel enabled accurate shot placement to
within approximately 5 mm, aiming for a minimum distance of
20 mm between skin impact locations at velocities unlikely to
perforate skin in an attempt to maximise the number of shots
but limit damage to adjacent skin. For those shots at higher vel-
ocities, a minimum of 40 mm between entry wounds was
attempted to prevent overlapping of the wound tracts. All shots
were fired at the posterior aspect of the leg and skin depth
(surface of skin to surface of muscle) was measured with calli-
pers at four points on each leg (superior, inferior, medial and
lateral).
DoP for each FSP perforating into muscle was determined
using a metal rod with graduated measurements. There was
some concern that this technique might not be accurate for the
Breeze J, et al. J R Army Med Corps 2013;159:84–89. doi:10.1136/jramc-2013-000065
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Table 2 Skin perforation velocities in relation to dimensions and masses of fragment simulating projectiles
S (mass over presented
Mass (g) Diameter (mm) Length (mm) Flat width (mm) Presented area (cm2) area g/cm2)
0.16 2.7 3.7 NA 0.057
0.49 4 4.8 NA 0.126
1.1 5.4 6.4 2.5 0.229
S, sectional density; Vth, threshold velocity.
deeper penetrations where it was difficult to feel the rear
surface of the FSP. In these cases, the metal rod was left in situ
and a plain radiograph taken to ensure that the rod was touch-
ing the FSP; should it be incorrect, the rod length could be
adjusted. DoP versus velocity was plotted for each size of FSP
into goat tissue using Microsoft Excel for Mac 2011 (Redmond,
Washington, USA) and the gradient and intercept of the line of
best fit compared with that of gelatin using a Student t test with
a significance of <0.05. Mean DoP for shots into the left legs
were compared with those into the right.
RESULTS
Skin thickness was between 3.0 and 3.5 mm (mean 3.2). A total
of 77 shots were fired using three sizes of FSPs. Values for V50
and Vth are demonstrated in Table 2. The Vth for each FSP was
lower than that predicted by the empirical equation suggested
by Mattoo8 (Figure 3).
Graphical representation of a linear correlation for the results
of DoP versus V50 between goat skin and muscle and 20% bal-
listic gelatin is demonstrated in Figures 4–6. There was no sig-
nificant difference in the gradients of the regression lines
between the gelatin and animal data for both the 0.16 g
( p=0.14) and 1.10 g FSPs ( p=0.93). Although there was close
correlation between the gradients of the regression lines for the
0.49 g FSP, the gradients were significantly different ( p<0.001).
There was no significant difference in the intercept of the
regression lines between the gelatin and animal data for the
1.10 g FSP ( p=0.76). There was a significant difference for
the intercept in both cases. No tumbling of FSPs was seen when
the high-speed videos of gelatin penetration were reviewed.
There was no statistical difference ( p<0.05) in DoP measured
for shots into the left legs (mean 52 mm) compared with the
right (mean 56 mm).
Figure 3 Radiographs of metal markers inserted into wound tracks
used to increase the confidence in accurately predicting depth of
penetration of fragment simulating projectiles (FSPs); note FSPs lodged
under contralateral skin surface.
Breeze J, et al. J R Army Med Corps 2013;159:84–89. doi:10.1136/jramc-2013-000065
Original paper
Predicted Vth (m/s)
V50 (m/s) + 95% CI Vth (m/s) using Mattoo equation
2.79 121.1 (7.6) 101.7 109.4
3.89 103.7 (21.1) 66.0 94
4.8 97.8 (10.8) 76.0 83.4
DISCUSSION
The aim of this study was to ascertain values for skin perfor-
ation velocity and DoP into muscle using a goat model as a sur-
rogate for humans using standardised variables and a precise
methodology. These results could not be ascertained from any
of the previous published studies using goats due to a lack of
standardisation in methodology. This study has produced clear
data for skin perforation velocities and generated algorithms
describing velocity versus predicted DoP into muscle for three
standardised projectiles which will be used to improve the fidel-
ity of future injury models.
There was a significant difference in the V50 required to per-
forate skin compared with the surface of the gelatin block for
the 0.16 and 0.49 g FSPs, reflecting the importance of skin in
retarding these lighter missiles at low velocities. Skin retardation
by goat skin was less than found in comparable pig testing,4
confirming their biomechanical differences. There was no sig-
nificant difference in either the intercept or the gradients for
V50 versus DoP between animal and gelatin for the 1.10 g FSP,
demonstrating that 20% gelatin is an excellent tissue simulant
for goat muscle for this particular FSP. Due to the significant
retardation of the 0.16 and 0.49 g FSPs by skin, it is not pos-
sible to comment on the gradient of the line of best fit between
DoP and V50 to determine if 20% gelatin is a good tissue simu-
lant for goat muscle for these FSPs. Ideally this experiment
would be repeated with firings of these two FSPs into goat
muscle with the skin removed, as well as 20% gelatin with a
validated skin simulant. Such a simulant is also essential for the
testing of the skin perforation of low density and non-metallic
fragments, the likes of which can be produced by buried explo-
sive devices.34 Existing skin simulants lack standardisation in
materials used and availability and we would recommend
further research into their development.
The Vth required for skin perforation for all three fragment
sizes in our study were less than that predicted by Mattoo’s
Figure 4 Skin perforation threshold velocity (Vth) versus sectional
density (g/cm2) for three standardised fragment simulating projectiles
as determined by our experiment, compared with the empirical line of
best fit derived from Mattoo’s 8 prediction.
87
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Original paper
Figure 5 Linear correlation of values relating depth of penetration to
V50 velocity for 0.16 g cylindrical fragment simulating projectile fired
into both 20% gelatin and goat skin and muscle.
equation8 based on PMHS skin. Although this may represent a
significant difference between goat and human skin, we believe
that it more likely reflects that Vth is a statistically poor measure-
ment that is subject to high variability. Only a single unrepresen-
tative low velocity shot is required to skew the data unlike the
V50 which represents the velocity at which 50% of fragments
perforate and which can also be ascribed a confidence limit. V50
measurements were also different from other experiments that
used the same measurement and not Vth. The V50 for skin pene-
tration for a 1.10 g fragment was 97.8 m/s, much higher than
the 60 and 62.7 m/s found by Sperrazza and Kokinakis10 and
Lewis et al27 respectively who used 1.0 g fragments. We believe
this reflects that both of their studies used isolated goat skin,
which is unlikely to be representative of human skin penetration
due to the lack of support provided by the muscle layer beneath
it.5 11 We would recommend that future studies of skin perfor-
ation should also determine the value of V50 instead of Vth,
with consideration of calculating the V01 (the velocity at which
only 1% of fragments perforated) should a high confidence of
non-perforation be required.
Skin thickness in our study ranged from 3.0 to 3.5 mm,
similar to the 3–4 mm described in previous ballistic goat skin
studies.10 20 Skin was shown to be the main component in the
resistance of tissues to projectile penetration, and once skin was
perforated it travelled very easily through muscle. Many FSPs
had enough residual velocity following skin entry to traverse the
whole thickness of muscle but not enough to exit through skin.
Figure 6 Linear correlation of values relating depth of penetration to
V50 velocity for 0.49 g cylindrical fragment simulating projectile fired
into both 20% gelatin and goat skin and muscle.
88
Figure 7 Linear correlation of values relating depth of penetration to
V50 velocity for 1.10 g chisel-nosed cylindrical fragment simulating
projectile fired into both 20% gelatin and goat skin and muscle.
Plain radiographs demonstrated that the fragments lay directly
beneath the contralateral skin surface (Figure 7) in an identical
manner to that often found at human postmortems.14 The
importance of skin in the retardation of lighter FSPs, especially
at lower velocities, means that it could be theorised that areas of
the body with thicker skin may potentially be more protected
against ballistic fragments and future work is required to quan-
tify this effect.
Significant gaps in our knowledge of the ballistic penetration
of skin and muscle to explosive fragmentation still exist. A lack
of comparable methodology between papers and limitations in
variables highlight the importance of undertaking further
research. Although extensive research has been undertaken in
the characterisation of the mechanical properties of living
human tissues, very little research has been undertaken to char-
acterise that of PMHS tissues.35 Existing PMHS papers have not
stated in what manner the tissue was preserved, but it would be
highly likely that storage was in formalin, which causes cross-
linkages in tissue proteins making tissues stiffer and less
elastic.35 36 Future research is therefore required to quantify the
differences in the mechanical properties between living human
skin and PMHS skin to predict how they may behave differently
when ballistic fragments are fired into them. If significant differ-
ences are found then it would suggest that existing PMHS data
may be flawed and that repeating these experiments with newer
methods of preserving PMHS skin such as fresh-frozen
storage35 is indicated. It has been suggested that hot and wet
skin, as experienced by service personnel currently deployed to
Afghanistan, is more susceptible to penetration.37 These results
have never been quantified by ballistic testing and future testing
is required to determine how skin temperature and moisture
content affect the perforation velocity for skin of explosive frag-
ments. Finally, the steel cylinder is generally considered the
most representative shape of randomly produced explosive frag-
ments.2 6 7 This is based upon collection of fragments produced
by explosive devices in Arena trials and those found embedded
in PPE. Further research is required to produce a broader
sample of fragments to either justify the use of the cylinder or
determine a more representative shape. This will require accur-
ate characterisation of fragments removed from injured service-
men as well as those visualised with radiology.
Contributors Design: JB and GRJ; Literature review: JB and GRJ; and Manuscript
preparation: JB, GRJ and AEH.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Breeze J, et al. J R Army Med Corps 2013;159:84–89. doi:10.1136/jramc-2013-000065
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Perforation of fragment simulating

projectiles into goat skin and muscle
Johno Breeze, G R James and A E Hepper

J R Army Med Corps 2013 159: 84-89

doi: 10.1136/jramc-2013-000065

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