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Forensic Wounds

Presented by

Dr Mbwas Isaac Mashor

BhUTH, Jos Campus

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Wounds - Definition

  • In medicine, a wound is a type of physical trauma wherein the skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion, or haematoma (a closed wound)
  • Wounds could be Bruises, Abrasions, Lacerations, Incisions, puntures, penetrating perforating, Cut Throats, Stab Wounds & Injuries in Road Traffic Accidents

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Bruises

  • Also called: Contusion, Ecchymoses, Haematoma
  • A bruise is a mark on skin caused by blood trapped under the surface of the skin
  • It happens when an injury crushes small blood vessels but does not break the skin
  • Those vessels break open and leak blood under the skin
  • Bruises are often painful and swollen. You can get skin, muscle and bone bruises. Bone bruises are the most serious.
  • It can take months for a bruise to fade, but most last about two weeks.
  • They start off a reddish color (haemoglobin), and then turn bluish-purple and greenish-yellow (bilirubin) before then gold brown (haemosiderin) returning to normal.

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Haematoma/ Ecchymoses

  • Is the accumulation of blood within tissue.
  • It is when it is relatively insignificant that it can also be referred to as a bruise.
  • Ecchymoses- is a type of haematoma( i.e bruises) - >1 to 2 cm in size
  • Purpura: from 0.5-1cm
  • Petechiae: Less than 0.5cm

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Contusion

  • This is an injury caused by a blunt force that damages small blood vessels and causes interstitial bleeding, usually without disruption of the continuity of the tissue
  • With superficial contusions, the bleeding is usually evident almost at once
  • With deeper contusions, of skeletal muscle, for example, the bleeding may not be evident for many hours and may leave only swelling and tenderness at the site.
  • Older individuals with small-vessel fragility may sustain extensive haematomas at contused sites.

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Abrasions

  • This type of skin injury represents basically a scrape or a graze, in which the superficial epidermis is torn off by friction or force on a rough surface.
  • Regeneration without scarring usually occurs promptly unless infection complicates the process.

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Abrasion. �Note the superficial tears in the epidermis. There is bleeding under the skin as well.

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Laceration

  • A laceration is an irregular tear in the skin produced by overstretching.
  • It may be linear or stellate, depending on the tearing force.
  • Typical of a laceration are the bridging strands of fibrous tissue or blood vessels across the wound.
  • The immediate margins of the laceration are frequently hemorrhagic and traumatized.
  • Deep tissues and organs may sustain lacerations from an external blow with or without apparent superficial injury. For example, when the unrestrained body impacts on the steering wheel in a head-on collision, the liver or spleen may sustain fatal lacerations.

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Laceration of the scalp.� The bridging strands of the fibrous tissue are evident.

Laceration of the scalp. The bridging strands of the fibrous tissue are evident.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 7 May 2007 03:34 PM)

© 2007 Elsevier

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Incisions

  • An incision is made by a sharp cutting object, such as a knife (scalpel) or a piece of glass.
  • The margins of the incision are usually relatively clean, and there are no bridging strands of tissue.
  • Incision, in contrast with the laceration, can usually be neatly approximated by sutures, leaving little or no scar.

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Puncture wounds

  • A puncture wound doesn't usually cause excessive bleeding. Often the wound seems to close almost instantly.
  • Results from stepping on a nail or being stuck with a needle on the skin— can be dangerous because of the risk of infection. The object that caused the wound may carry spores of tetanus or other bacteria, especially if the object had been exposed to the soil.
  • Puncture wounds resulting from human or animal bites, including those of domestic dogs and cats, may be especially prone to infection. Puncture wounds on the foot are also more vulnerable to infection.
  • If the bite was deep enough, bleeding may result

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Wounds - others

  • Penetrating wounds - Caused by an object such as a knife entering the body
    • Usually deep and narrow with an entrance wound but no exit wound
  • Perforating Wounds –
    • Usually has an entrance wound and an exit wound
  • Gunshot wounds - caused by a bullet or similar projectile driving into or through the body. In perforating gunshot wounds, the entrance wound is smaller than the exit wound

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Cut Throat

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  • Suicide
  • Homicidal- Jack the ripper -1880’s in the white chapel area of London, Mafia styled killing
  • Accidental

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CUT THROAT

    • Bangladesh Med Res Counc Bull. 1997 Dec;23(3):87-90.

�Cut throat injury: a retrospective study of 26 cases.��Bhattacharjee N, Arefin SM, Mazumder SM, Khan MK.��

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CUT THROAT- circumstances

  • Familial troubles, psychiatric illness and poverty were the triggering factors in suicidal attempts.
  • The motives of homicide included political conflict, sex related crimes, familial, land related disputes
  • All usually have their hypopharynx and/or larynx exposed

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Cut Throat- Nigerian Cases

�Afr J Med Med Sci. 2001 Sep;30(3):233-5

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Management of the upper airway in severe cut-throat injuries.��Ezeanolue BC.��Department of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria.��Four patients treated for cut-throat injuries are the subjects of this paper. Two were self-inflicted suicide attempts while one each was for ritual killing and over disputed farmland. Tracheostomy was deplored at the early period in all cases to ensure safe and patent airway. Significant laryngo-tracheal stenosis was a long-term morbidity suffered by two of the patients.

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Anatomy of the neck

  • 1 Skin and subcutis
  • 2 Spine of cervical vertebra
  • 3 Trapezius and other supporting
  • musculature
  • 4 Spinal cord
  • 5 Vertebral disc
  • 6 Sternocleidomastoid muscle
  • 7 Internal jugular vein
  • 8 Common carotid artery
  • 9 Oesophagus
  • 10 Trachea
  • 11 Thyroid cartilage
  • Schematic representation of the major structures of the human neck – transverse section at the laryngeal level

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Cut throat

  • The next three slide illustrate the extent of damage possible with cut throat injuries
  • Areas not shaded illustrates the extent of injury in the neck and the vital structures that are damaged that result in the death of victims

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Example I

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Example II

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Example III

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Cut Throat- Cause of death

  • Haemorrrhage/Shock
  • Aspiration of the blood
  • Laryngeal edema
  • Asphyxiation

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Injuries In Road Traffic Accident (RTA)

  • Motor Vehicle RTA
  • Paedestrian RTA
  • Motor Cycle RTA

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Injuries In Road Traffic Accident (RTA)

  • Pattern of injury depends on the circumstances of the accident.
  • High income and developed countries (HIC) have less casualty than the Low and Middle income countries (LMIC) like Nigeria.
  • HIC have better safety standards, good roads and laws and law enforcement on their roads. The reverse is the case in the LMIC

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Central Nervous System

  • Skull fracture – base of skull fracture
  • Intracranial Haemorrhages- Epidural, sub- dural, subarachnoid, intracerebral
  • Brain contusion and Laceration
  • Coup and counter coup lesions
  • Diffuse Axonal Injury
  • Whip lash injury in the spinal cord
  • Spinal cord transection usually at C3- C4 segment

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Epidural / Subarachnoid haemorrhage

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Eye

  • Globe rupture
  • Intraocular foreign bodies
  • Hyphema
  • Orbital bone fracture
  • Transection of the optic nerve

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Serous Cavities

  • Haemopericardium
  • Haemothorax
  • Haemoperitoneum

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Cardiopulmonary System

  • Haemopericardium
  • Cardiac laceration
  • Lung contusions and puncture of pleura space with Pneumothorax and compressive lung collapse- resultant from rib fractures

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Abdomen

  • Hepatic Laceration
  • Spleenic rupture
  • Renal laceration/rupture
  • Pancreatic laceration
  • Ruptured viscus

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Other types of Injury

  • Long bone fracture/ facial bone fracture
  • Pelvic fracture with bladder rupture
  • Open and closed haemorrhages from abdominal organs can lead to haemorrhage/shock
  • Burns from vehicular fires

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BURNS

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References

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