Wounds

Front 1

definition of wound

Back 1

•a disruption of the anatomical continuity of tissues caused by application of mechanical force to the body.

Front 2

legal classification

Back 2

Slight/Simple wound

Dangerous wound

Mortal wound

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A permanent infirmity

Back 3

•isa serious complication which may follow injuries. It means loss of afunctioning organ or loss of the function of this organ (partially orcompletely).

Front 4

A disfigurement

Back 4

•lossof a non-functioning organ e.g. loss of a part from the external auricle of theear.

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Medicolegalclassification

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1. Abrasion

2. bruise

3. Incised (cut) wound

4. Contusion (lacerate) wound

5. Stab wound

6. Punctured wound

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Definition of abrasion

Back 6

•superficialinjury which involves only the outer layers of the skin. It is caused byfriction or pressure between the skin and any rough blunt or sharp objects. Itbleeds very slightly, and heals rapidly without leaving any scar.

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Types of abrasion

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a- Scratch:

•Itis a linear injury produced by a sharp object, such as pins or finger nailsrunning across the skin.

Slidingabrasion: It is an injury that occurs when a broadarea of the skin slides or scrapes against a rough surface. It is commonly the result of trafficaccidents or when the body has been dragged.

•Pressure or contact abrasion: It isan injury that occurs as a result of direct impact, pressure or contact withsome objects which cause crushing of the cuticle and reproduction of its shape.

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•Medicolegalimportance of abrasions:

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•1-Presence of abrasions on the body is a sure sign of violence and struggle.

2-The presence of an abrasion suggests the site of external impact, and it may bethe only external sign of a serious internal injury e.g. ruptured viscera.

3- Theirsite on the body may give an idea about the type of the crime.

4- Identificationof the causative instruments.

5- Directionof injury: this may be identified by the heaped up epithelium at the end ofabrasion.

6-Time passed since infliction of abrasions.

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Definition of bruise

Back 9

•aninfiltration or extravasation ofblood into tissues following rupture of blood vessels, as a result ofapplication of violence with blunt instrument (e.g., a stick, stone) or bypressure of the finger. It is usually subcutaneous with intact skin.

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Medicolegal importance of bruises

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1)Identification of the causative instrument,from itsshape.

2)Identification of the type of crime from the site of the bruises on the body.

3) Time passed since infliction of abrasions.

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Incised(cut) wounds

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•Theyare wounds that caused by drawing the edge of a sharp instrument (e.g., razor,knife, sharp-edged metals or pieces of broken glass) along the surface of theskin.

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Charactersof incised wounds

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•1-Atypicalincised wound made by a sharp knife, has sharp regular edges with clean cutbase. But the edges may be irregular when:•a.The skin is loose (corrugated), e.g., axilla, neck or scrotum.b.The wound is caused by pieces of glass

•2-Thelengthof the wound is greater than its depth and having no relation to size and shapeof the causing instrument.

•3-Nobridgingof tissue across the clearly cut edges because all tissues are cleanly divided.•4-Hairatthe edges is sharply cut.

•5-Noabrasionsor contusions around the edges.

•6-Bleedingisprofuse and escapes freely, because the blood vessels are cut across and nottorn.

•7-Theincisedwounds tend to gap owing to the retraction of the skin and fibrous tissues dueto their elasticity.

•8-Lessliabilityto sepsis because of the minimal tissue destruction.

•9-Itusuallyheals by first intention, leaving a thin scar.•

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Contused wounds

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Theyare wounds in which the tissues are split or torn. They are caused by kicks orblows by heavy blunt instruments, e.g., heavy sticks, iron bars or stones or byfalls on rough objects

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Charactersof contused wounds

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•1-Theedgesof the wound are irregular and often bruised and may be surrounded byabrasions.

•2-Bridgingofthe tissues across the edges due to incomplete separation of the tissues.

•3-Crushingofthe hair present at the edges of the wound.

•4-Externalhaemorrhage fromthe lacerated wound is slight because the blood vessels are usually crushed,but internal haemorrhage fromruptured viscera may be severe and lead to death.

•5-Theyaremore liable to sepsis because of the excessive tissue destruction.

•6-Theytakelonger time to heal and usually heal by second intention leaving thickpermanent scar.

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Typesof contused wounds

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a. Ordinary contused wounds.

b-Split wounds (incised like wounds)

c.Torn wounds or flap wounds

d. Crushed wounds (Avulsions)

e. Lacerated wounds

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Stabwounds

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•Theyare wounds caused by forcing a sharp pointed instrument (knife, dagger, andsword) through the skin, and its depth is the greatest dimension

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Typesof stab wounds

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•Penetrating stabwounds:when the weapon enters a body cavity as thorax or abdomen.

•Transfixing stabwounds:when the weapon after penetrating the tissue comes out from the other sidemaking an exit wound.

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Charactersof a typical stab wound

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•1-Ithasregular cleanly cut edges.

•2-Itsdepthis more than its length.

3-Theshapeof the wound may sometimes correspond to the weapon used, and it gives an ideaabout the causative instrument.

•4-Thelengthof the stab wound is relative to the breadth of the blade of the instrument,generally a little smaller, but the wound may be enlarged on withdrawing theinstrument.•5-Abrokentip of the weapon may be found as a foreign body inside the wound, helping toidentify the causing instrument.

•6-Externalhaemorrhage isusually limited in amount, but serious internal haemorrhage may result from penetrating wounds ofthe •thoraxandabdomen.

7-Stabwoundsare more dangerous than the previous types because they may injure the internalorgans, introduce sepsis to the deep organs and their depth makes themdifficult to clean

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Punctured wounds

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•Theseare caused by pointed-end instruments with no sharp edge (nail, poker or closedscissors). •Itmay be rounded, triangular or star shaped according to the cross section of thecausing instrument without loss of tissues.

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Causes of death in wounds

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1. Immediate causes:

- Embolism

- Hemorrhage

- Fatal shock

2. Delayed death:

- Infection

- Surgical interference