The band's debut, "Slave to the Scalpel" saw 200 Stab Wounds insinuate themselves into the minds of extreme metal fans, leading to praise from Pitchfork for their “unpretentious brilliance, pitch-black sense of humor” and an “aesthetic [that’s] built around a chugging, groovy riff that stomps down a path of destruction.” Manual Manic Procedures sees the band upping the ante both musically and lyrically.

Ultimately, for 200 Stab Wounds, it’s all about creating art that they enjoy. “I know that if we like it, our fans will like it,” says Buhl. “That's really all that matters to us. And if we keep touring, it's just gonna get bigger and bigger. Then everyone's happy, far as I'm concerned.”

The songs on Manual Manic Procedures are not safe for work – perhaps unsafe most anywhere. But that’s its dark charm in a world where even heavy music can play it too safely. 200 Stab Wounds have crafted Manual Manic Procedures for themselves and like-minded brethren: thrill-seekers, carnage cravers, horror fans, and aficionados of the most extreme metal. Above all, 200SW created a future death metal classic.