Wound =

Any solution or breach in the natural continuity of a tissue or organ

caused by application of mechanical force to the body.

CLASSIFICATION OF WOUNDS.

Legal classification: according to results, time of tx, and punishment.

Slight/Simple Wound:

Heals rapidly.
<20days.
No deformity, no
permanent infirmity.

Dangerous Wound:

Heals >20 days.

or
Leaves a
permanent
infirmity.

Fatal/Mortal Wound:

Causing death
immediately
Or
Later due to
complication

Medicolegal classification: according to instruments used.

Blunt
instruments
Abrasions
Contusion
s
Contused
Lacerated

Sharp
instruments
Inscised
Stab

Firearm Wounds
Gunshots

Physical Agents
Burns
Electrical
Radiation

Chemical Agents
Strong Acid
Strong
Alkali

How a wound is produced ?

Moving instrument/object on a stationary body. Eg: being stab upon.

Movement of body itself on a stationary ground. Eg: in falls.

FACTORS INFLUENCING THE TYPES AND EXTENT OF WOUNDS.

Instruments Used

-Type: blunt, sharp or firearm weapons.

-Size of striking surface area: small; screwdriver. Large; graze wound

(gravel).
-Shape of striking surface area: depends on the causal instrument.
-Material: plastic/wooden; less damage than rigid. *pt of energy used in
deforming
deforming or breaking the instrument.
Amount of energy
produced during
impact
State of the body
at the time of
impact
Nature of the
affected tissue

Measured by:
Velocity > Weight. Y?
o Weight instrument 2x = Kinetic energy 2x
o Velocity instrument 2x = Kinetic energy 4x
Biological fx: 1. Mobility of body part & state of body at the time of impact.
2. Anticipation and coordination.
o
o
o
o
o

Type of Wound
Definition

Skin: blunt; brusies. Skin split against rigid bone; skull,eyebrow.

Subcutaneous tissue: blunt force; bruise *Presence of fat & fragile
CT.
Muscles: crushed, torn, lacerated or ruptured.
Bones: bend (in children), fractured.
Body fluid and gases: Fluid; incompressible -> rupture. Gases;
compressible

Abrasion
Simplest form of wound, bleeding
is minimal, heals rapidly, localized
at the site of trauma.

Contusion (Bruises)
Extravasions of blood
in tissues following
ruptures of BV as
result of applied blunt
force.

Contused
Open injury
produced by imp
of blunt force ag
body.

Classification

Medicolegal
Importance

Scratches:
Longitudinal/linear. (drag
nails)
Semilunar/crescent. (nails dug
into skin)
Triangular (nails are pointed)
Small cut (nails are long)
Grazes:
Coarse: gravel
Fine: asphalt
Depth: fall -> elbow,hands
and knees.
Impression/Impact:
Caused- eg. Radiator of car
A.k.a pattern abrasion.
Pressure abrasion:
Common:
hanging/strangulation.
Bite abrasion:
Human bite: elliptical shape,
U.L on body. Eg. Rape, child
abuse.
Animal bite: 2 parallel raws.
LL on body. Eg. Canine bite.
Human marks on food

Depends on:
Amount of
violence.
Instrument used.
Condition & type
tissues.
Texture & colour of
skin.
Age. Child and
elderly easily
bruised.
Sex. Woman
bruised more
easily.
Certain disease.
Hypertension.
Gravity. Appear
places away from
site of bruise

1. Evidence of a crime or
violence. Eg. Signs of
resistance.
2. Idea about the type of the
crime.
3. Idea about the type of
instrument used from its
shaped. Eg. Finger nails.
4. Differentiate incised and
contused wounds.
5. Age of abrasions: date of
the crime.
6. Ante mortem and
Postmortem abrasion. *refer
pg 53.
7. Abrasion distinguished from

1. Evidence of a
crime or violence.
2. Evidence of signs
of resistance.
3. Age: date of crime.
4. Idea of the type
instrument.
5. Differentiate
between incised
and contused
wound.
6. Maybe cause of
death.
7. Differentiate from
hypostasis.

*Antemortem or
Postmortem bruise

Contused Wound
Crush of skin
2 hard object
Laceration
Edges are
severely
damaged,
irregular, mu
angle.
Crush Injury
Heavy, blunt,
mobile
instrument ru
over body.
Torn Wound
Caused by be
of machine.
Cut Laceration
Heavy, sharp
cutting
instrument.

*Differentiation
between hypostasis
and bruise. *Refer pg
56

1. Type of injury
causal
instrument.
2. Could stimula
incised of wo
in skin over b
3. If in the head
may occur
fracture.

postmortem injuries cause

by ants or insects,
excoriation of skin by
excreta seen in infants and
pressure sores.

Danger of Wound

1. Tetanus.
2. Erysipelas (acute fibrile
diseas w intense
edematous local
inflammation on skin.)

3. Neurogenic shock.
4. Injury to internal
organs.
5. Liability to sepsis
and death from
septicemia.

1. Liability to se
2. Neurogenic
shock.
3. Crush syndro
myoglobinuri
renal failure.
4. Fat embolism
5. Healing on sc
-> permanen
infirmity.

STAB
WOUN
D

forcing sharp pointed

instrument into e body,
having a sharp edge blade

Punctured

Thrusting a blunt
edge and pointed
end instrument

Penetrating

Stab/ puncture
reaching body cavity

Stab/puncture
which passes from
one side to anther

Perforating/Transfi
xing wound

Characteristic

Deep than long

Depth = length of blade
Width = breadth of blade
Edge cleanly cut (except in
punctured wound caused by
handle of knife)
Shape of wound = shape of
causal instrument.
Eg:- bibladed
-Monobladed
-Closed scissor
-Stab with rounded end of nail

1) Neurogenic shock

DANGERS
2) injury to internal organ
3) internal hge

of Stab
Wound

4) sepsis

Factors affecting the

Direction of thrust & withdrawal

knife is twisted when withdraw
(cruciate wound)
If direction of stab is oblique (oval
shaped wound)
Changes of shape when partial
withdraw & rethrusting it again
Change of shape with movement of
victim

DEFENCE
WOUND

BLUNT
weapon

Abrasion &
bruises on
forearm / back of
hands

Stabbing attack:
dt victims spontaneous
reaction of self-defence when
he is attacked either

grasp he weapon
raise his arm
ward off an attack

Grasp the knife;- cut

on the palms, on the
opposing fingers/thumb

SHARP
weapon

Ward off;- cuts on the

back of hands, wrist,
skin between thumbs &
fingers.

Slashing attack:
Serious cuts of the hand /

FABRICATED
WOUND
(SELF-INFLICTED WOUND)
Done by person himself to give suspicion
of self defence
or
by the aid of another person in agreement
with him.

Characteristi
c
1) Superficial, within the
reach of the person
2) Series of parallel lines /
crossing scissors
3) Tear of clothing not
corresponding to the
wound on body / not
compatible (length,
direction, nature, number)

1) Traumatic

CAUSES OF
DEATH IN
WOUND
1) Neurogenic
Caused by
1)
Traumatic
Shock
a)
shock (slowing of heartParasympathetic instant death)
Shock
Follow minor
trauma
Severe trauma (cut
throat)

b)Sympathetic
Shock

Death from
sympathetic
stimulation of CVS

2) Hematogenic
Shock /Surgical

Radual onset
Tissue injury:-

2) Hemorrhage

Neurogenic
Hematogenic

3) Infection
4) Embolism

eg
1- Pshycic shock
2- sudden rise
pressure in carotid
sinus
(+excitement)
3- minor painful
stimuli of trigger
zone
4- during minor
operation
5-impaction of
foreign body
6- sudden
distention of hollow
organ
7- pulling upon
intestinal loop
during operation
esp with light
anesthesia
1- painful stimuli
by emotion & fear
2- precipitating
factor:
-Previous heart
disease
-coronary
artherosclerosis
-fatty degeneration
of the heart
-chronic valvular
disease

Post-mortem
picture
1- History of
sudden death
following any
previous causes
2- tissue & organ
pale
Rt heart&big
veins empty
3- no conestion of
brain / lung

1-general
congestion of
organs
2-heart full of blood
3-pulmonary
congestion
&edema, petechial
hge under serous
coats

shock

1)Local loss of fluid

Reduced blood
volume
2)Release of
histamine like
substance causing
capillary dilatation

2)

Gravity of hge
depends on
1) amount of
blood loss
2) site of hge :
inside>external
peritoneal/pleu
ra is fatal if 1 liter or more
-pericardial
cavity is fatal if
200-300cc
blood (cardiac
tamponade)
-extradura/
subdural in
small amount is
fatal
-in brain
substance eg:
pontine hge
few cc is fatal
3)rate
Rapid>slow

Most common
Symptoms started to appear if pt loses
1liter of blood
Grave danger if he loses 2liter-1/3 of
total blood volume (external hge)

Type of hge
1) primary he
Immediately after
injury
2) Reactionary
hge
Delayed for
several hour>24h after injury
3) secondary hge
Dt infection
(10-16days)

Postmortem picture
External
Internal
1) large amount
1) pallor of organ
of blood at
scene/clothes,
2)heart & BV
with present of
empty of blood
wound
3) petechial hge
2) body looks
under serous coat
pale
esp endocardium
3) P.M hypostasis
ill define /
absent

4) contracted
spleen

4) general
condition of pt

Primary Infection
-invasion at the time of injury
-usually cant be avoided

3) Infection

Secondary infection
-invasion after the injury
- can be prevented by adequate
aseptic surgical measures

Caused by
1)normally present organism (staphylococci,
streptococci,pneumococci)
2)organism which invade the tissue from

4) Embolism
Air Embolism

Thrombotic
Embolism

Fat
Embolism

Amniotic
Fluid
Embolism

Minimum air to
cause
embolism =
60ml
*kindly refer to
the textbook
page 66 for
venous
&arterial air
embolism
differentiation

-injury to LL veins
leads to DVT
-the effect
depends on size
Eg: large branch
of pulmonary
artery can cause
lung infarction
-occurs 2-3days
after trauma / on
10th day of
operation

-dt obstruction of
blood flow
through
capillaries by fat
globules
-usually after
long bone
fracture, or it
may follow
severe injury or
burn in any tissue
Eg: pulmonary fat
embolism
<2days after
fracture
Cerebral fat
embolism
>2days after
fracture

As complication
of criminal
abortion / in case
of abdominal
trauma in
pregnancy
-amniotic fluid
escape & enter
maternal
circulation
causing death
by :
1) producing
disseminated iv
coagulopathy
2) diffuse
blocking of the
pulmonary
capillaries