I'd say this is a real and pretty nasty looking exit wound. I'm medical (nursing), former EMS. There's a lot of muscle here, speaking in terms of anatomy. Muscle tissue would be oxygenated and blood rich which is exactly what we see right here. However, there was no arterial damage (assuming that from the fact this guy is alive.) and this wound is fairly clean, which you would see in traumatic muscle damage such as this especially with this type of round. All in all the wound is fairly clean looking- (Unlike JFK, etc.). Think about it- you have thousands of pounds of kinetic energy, at fairly point blank/ close range and it's a rifle, not a sub-compact pistol or revolver. Not everything has a conspiracy behind it, ALTHOUGH- we do live in strange times.