TYPES OF WOUNDS
الجروح واالصابات
د .نوح حمدان
اختصاصي الطب الشرعي
البورد االردني الفلسطيني
الجامعة االردنية
1. BLUNT OBJECT WOUNDS
Bruises ( contusions )
– Abrasion سحجات
– Laceration خدوش
– Fracture and dislocations of teeth/bone
2. Sharp-edged weapon injuries
– Incised wound
- stab wounds
3. Firearmwounds
4) Thermal Injuries
1. Due to cold
–2. Due to heat
– Burns
– Scalds
5) Chemical injuries
1. Corrosion – corrosive acid/alkali
6) Miscellaneous injuries
1. Electricity
MEDICO LEGAL CLASSIFICATION
Suicidal injury
Homicidal injury (assault ) (1
Accidental injury
Defense wounds (1
Fabricated wounds ( self-inflicted) (2
ABRASIONS
Definition :
It is a type of mechanical injury characterized by loss of
superficial layer of skin (epidermis) or due to
application of mechanical force (rough blunt object)…
Features :
-pure abrasions involve epidermis only. abrasions do
not bleed or bleed minimally
-Abrasions do not leave a scar on healing.
Mechanism of production :
The mechanical force producing abrasion acts
on the skin in one of the following :
1- sliding force (friction) 2- compression force
Linear abrasions ( scratch )
Pressure abrasion
Imprint abrasions
.
Can abrasions happen after
death ?
MEDICO LEGAL IMPORTANCE OF ABRASIONS
1. direction of force used to inflict abrasion can be
known
[Link] of weapon/object used can be identified
[Link] of crime can be determined from the age of
abrasion ؟؟؟
4. Can give idea about some type of offenses
committed. For example abrasion close to female
genitalia Similarly abrasion at neck Abrasion around
mouth and nose may be suggestive of smothering.
5. Presence of foreign material along with abrasions,
such as sand particles, mud, dirt, grease etc. may
CONTUSIONS الرضوض والكد مات
Definition :
A contusion is an extravasation or collection of
blood due to rupture of blood vessels caused
by application of mechanical force of blunt
nature without loss of continuity of tissue. the
word ‘bruise’ usually implies that the lesion is
visible through the skin or present in the SC
tissue, while ‘contusion’ can be anywhere in the
body such as spleen and muscles.
MECHANISM
Contusion is caused by blunt force impact
causing crushing or tearing of subcutaneous
tissue or dermis without breaking the overlying
skin or mucous membrane. Due to rupture of
blood vessels, there is extravasation of blood
out of vessels and collected underneath the
tissue. Collection of blood is accompanied by
swelling and pain.
PATTERNED BRUISES
These contusions are called as patterned contusions
because in such contusions, the imprint or design of the
Offending weapon or object is imprinted over the skin..
•Examples – impression of motor tyre, impression of
rubber sole of
shoes, etc.
SHIFTING BRUISES
• Bruises that appear at different site from the actual site of
application of
mechanical force..
• When the bruise is located in deep tissue then it gravitational force
acting.
• An example of contusion in forehead. If the victim survives for
some period after sustaining bruise then the contusion in
forehead can slide downwards over the eyebrow and appear as
black eye.
Similarly bruises situated at leg may gravitate downward to appear
at lower
surface around ankle .
TRAMLINE CONTUSIONS
Also called as rail-way contusion or tram-track contusion
•These contusions are caused by blow with rod, stick,
whip or belt etc.
•The contusion is characterized by two-parallel tram-
track like lines of hemorrhages with intermediary area of
skin remains intact.
•Mechanism – blow with object like stick or rod over skin
causes the skin under the part of contact of weapon to
get
compressed. Due to compression of skin by the
offending object or weapon, the blood in that part is
displaced sideways causing tram- track like
FACTORS AFFECTING COLOR AND
SIZE OF BRUISE
Age : elderly bruise easily Body part
Diseases : Vit k , c deficiency , liver
disease .. Medications :steroids ,
anticoagulation
MEICO LEGAL IMPORTANCE
Bruises have less value than abrasion because:
•The size may not correspond with the size of
offending weapon
•The bruise may visible immediately or may be delayed
in appearance
•The bruise may shift from the actual site of assault to
other site as ectopic contusion
•The contusions do not indicate the direction of the
force applied May indicate a serious underlying injury ,
like fracture , internal
AGINGTHE BRUISE
We cannot and
We don’t age the bruise
Laceration wounds/Injuries
) السحقية, المتهتكة, (الرضية
These are the wounds caused by the blunt
force resulting torn of the skin and the
underlying tissue , with little bleeding.
Features of the lacerated wounds
Edges are ragged , irregular and contused.
Margins are abraded due to impact of blunt
force. Deep tissues are crushed.
Tissue bridges
Hair bulbs are crushed.
Less bleeding due to crushing of underneath
vessels. Presence of foreign materials.
Shape-Irregular..
Medico-Legal importance
Homicidal-occurs in any part of the body. produced by
blows with
hard and blunt weapon.
Accidental-Road traffic accidents, accidental fall from
height. Trace matter may be found in laceration
(foreign bodies-Mud,oil
etc.)
Distribution and shape may help in forensic
reconstruction of
event .
Suicidal-Very rare.
1. Cause of injury can be known.
[Link] bodies present in wound may
help in identification
of the offending weapon/place of incident
etc.
[Link] of injury can be estimated.
[Link] can be known whether the injury is
accidental or suicidal
or homicidal.
[Link] of application of force can be
known.
Incised wounds (cut ,slash,slice)
Clean cut through tissues , usually skin and subcut, by
sharp edged or cutting weapon (knife , sword, glass)
Edges are smooth clean cut and no bruising along the
edges ..
DUE TO SKIN ELASTICITY Linear wound ,broader than
the edge of weapon
Length is greater than depth.
BLEEDING IS PROFUSE
All tissue are clearly divided and there is no tissue bridging .
As vessel are cut , bleeding are profuse even in small
incised wound .
At the commencement , the tissues are more deeply cut
and tails off at the end . This indicates the direction of the
wound .
.
Medico-Legal importance
Homicidal-Any part of the body, commonly on the neck,
passing across the throat below thyroid cartilage, head
and trunk, also be found on the inner side of forearm or
hand of victim while defending or protecting. ‘Defense
Wounds’.
Suicidal-Found in the accessible parts by light weapons
on the throat (above thyroid cartilage). Tail end of the
wound indicates which hand has been used(left hand
usually),hesitation cuts , no defense cuts , not damaged
clothes.
Accidental anywhere .
LACERATION VS INCISED WOUND
Laceration Incised wound
Hair and hair bulb are crushed Hair and hair bulb are not crashed
Edges are bruised Edges are not bruised
Base of wound has bridging across No bridging
muscle
fibers
SELF INFLICTED WOUNDS
Also called fabricated wounds
• These injuries are on the accessible part of the body.
• They are usually superficial.
• They are regular.
• Similar in style or shape.
• Multiple.
• Parallel or grouped together.
• Handedness – in right-handed person, injuries are predominantly
on the left side and for left handed person; the injuries are inflicted on right part of body.
• Old scars of previous attempt of self-infliction may be noted.
• There may be any underlying psychiatric disorder.
DEFENSE WOUNDS
•Defense wounds are the injuries inflicted to a person
when he tries to defend himself against an attack.
•The person may ward-off the weapon or trying to
catch or
grabbing the weapon – cuts the palm and ulnar aspect
of hand.
•To protect the exposed surface of body, the upper
limbs– extensor surface of forearms (ulnar side), the
lateral/posterior aspect of arm and dorsum of hand
may receive injuries.
•Similarly the anterior and posterior aspects of lower
limbs and back may be injured when an individual with
Stab wound
A stab wound is produced by thrusting of any pointed
object into the body so that the depth is the greatest
dimension of the wound .
Examples : including knives ,, dragger ,, scissors , etc .
Type :
perforating stab wounds
When stab would also make an exit
. Penetrating stab wounds
When body cavity like abdomen ,
thorax is penetrated .
.
Medico-Legal Importance
Shape of wound indicates the type of weapon.
The depth of the wound indicates the force of the
penetration.. Age of the injury can be determined.
Position, number and direction of wounds can give clue for
manner of production-Suicidal, Accidental, Homicidal.