FORENSIC SEMINAR

WOUND

DEFINITION

damage to any part of the body due the application of

mechanical force

requires the integrity of the body surface to be

breached

CLASSIFICATION

Abrasions
grazes or
scratches.
Contusions
bruises.

Lacerations
cuts or tears.

Incised wounds
cuts, slashes or
stabs.

ABRASION

does not penetrate the full thickness of the epidermis.

does not bleed, as blood vessels are confined to the

dermis.

discoloured and moistened by exuded tissue fluid

Mostly caused by a lateral rubbing action rather than

vertical pressure.

ABRASION

TANGENTIAL ABRASION (brush)

wide tangential impact (gravel rash)
a rough surface scrapes linear furrows across
the skin
dragged along the ground, pedestrian accidents

ABRASION

CRUSHING ABRASIONS
the impact is vertical to the skin surface, no scraping or
tangential marks occur.
an imprint of the impacting object is stamped on the
surface
slightly depressed below the surface unless an
underlying bruise or local oedema bulges the tissues.
marks of a vehicle radiator on a pedestrian victim or the
pattern of a floor grid on to which a person has fallen.

ABRASION

FINGERNAIL ABRASIONS
important because of their frequency in assaults
especially child abuse, sexual attacks and
strangulation.
the neck, the face, THE UPPER ARMS and the forearms.
linear scratches if the fingers are dragged down the
skin,(victim) or short, straight or curved marks when
the skin is gripped in a static fashion.(assailant)
woman > men

ABRASION

PATTERNED ABRASIONS
the force is applied at or near a right angle to the
skin surface
the skin may be compressed into the cavities of
the pattern, with consequent capillary damage
leading to an intradermal bruise.
a motor tyre passes over the skin, leaving a
pattern

ABRASION

POST-MORTEM ABRASIONS

inflicted after death from a variety of causes,

including dragging a corpse, animal injuries,
autopsy
post-mortem interval increases, the skin
becomes more fragile.

CONTUSION

Lies beneath an intact epidermis and consists of an

extravascular collection of blood that has leaked from
blood vessels damaged by mechanical impact.

larger than a few millimetres in diameter

smaller = ecchymosis

even smaller = petechial haemorrhage

suction

CONTUSION

bruise = lesion is visible through the skin or present

in the subcutaneous tissues

contusion = anywhere in the body

CONTUSION

FACTORS AFFECTING THE PROMINENCE OF A BRUISE

sufficient space outside that vessel for free
blood to accumulate ; eye socket, scrotum
Resilient areas : bone acts as anvil with
the skin between the bone and the
inflicting force.

the amount of blood in the extravasation,

fragility of vessels

CONTUSION

FACTORS AFFECTING THE PROMINENCE OF A BRUISE

The depth :
superficial = minute
subcutaneous = most bruise, fairly
obvious
deep fascia = confined

CONTUSION

FACTORS AFFECTING THE PROMINENCE OF A BRUISE

continue bleeding or free blood from original
bleeding upwards
haemolysis ; haemoglobin stains tissue more
diffusely and noticeably
*post mortem bruise

CONTUSION

MOVEMENT OF BRUISE
may appear at a different place on the surface
from the point of impact.
may take time to reach the surface (if it ever
does), and this may be some distance away
because of deflection and obstruction by
fascial planes and other anatomical structures.
bruises may move under gravity.

CONTUSION

ALTERATION OF BRUISE
healing process
fresh blood = dark red (purple through
skin)
hemolysis and haemoglobin breakdown =
bluish brown, greenish brown, green,
yellow, fade
within 1 week

CONTUSION

SPECIAL SIGNIFICANT BRUISING

Six- penny bruises : Clusters of small discoid
bruises of about a centimetre in diameter are
characteristic of finger- tip pressure from
either gripping or prodding.
Love bites : a shower of small petechial
lesions caused by oral suction on the skin

CONTUSION

SPECIAL SIGNIFICANT BRUISING

tram-line or railway-line : two parallel lines of bruising
with an undamaged zone in the centre.
weapon sinks into the skin on impact so that the
edges drag the skin downwards and the traction
tears the marginal blood vessels i.e. broom handle

CONTUSION

SPECIAL SIGNIFICANT BRUISING

Black eye : not all black eyes are true bruising from a
blow in the orbit. Some are from fractured orbital roofs
and others are the result of gravitational movement of a
forehead injury.
Kicking : most victims are already lying or sitting on the
ground boot is put in towards the concavities of the body.
(fetal position)
The major characteristic of most kicking injuries is
the severity of bruising and underlying damage.

LACERATION

The continuity of the tissues is disrupted by tearing rather than

clean slicing, but the distinction is often blurred because some
lacerations are caused by jagged projections ripping into the
skin in much the same manner as a blunt knife or axe.
Require a firm base to act as an anvil for the skin and
underlying tissue to be pinned against.
the lacerating agent is either a projecting point or edge, or a
completely blunt object
usually associated abrasion and bruising

LACERATION

sandwich effect
a blow from a blunt instrument can cleanly split
the tissues against the skull, leaving a linear
wound that appears to the inexperienced to be a
knife or chopper cut.

LACERATION

DISTINGUISH LACERATION WOUND

the bruising and crushing of the margins
the persistence of tissue strands across the
interior of the wound
the absence of a sharply linear injury in the
underlying bone
intact hairs will survive to cross the wound
edge of the wound to differ from the other :
edged object

LACERATION

DISTINGUISH LACERATION WOUND

FLAYING INJURY : a large area of skin and
subcutaneous tissue is rolled off

LACERATION

PATTERNED LACERATION
Lacerations do not reproduce the shape of the
injuring agent nearly as well as do abrasions and
intradermal bruises.
A heavy focal blow may cause a linear or a
stellate laceration
Firearm wounds are a special form of laceration

PUNCTURED WOUND

a hybrid between lacerations and incised wounds

metal spikes, wooden stakes, garden or farm forks,
and a variety of vehicular and industrial accidents.
When a blunt spike is driven through the skin, there
will be inversion and abrasion of the edges
may vanish if the weapon has been withdrawn.
Foreign material such as rust, dirt or splinters may
be left in the wound

INCISED WOUND

Injuries caused by sharp objects

knife, sword, razor, glass or sharp axe
clean division of the skin and underlying tissues so
that the margins are almost free from any damage

INCISED WOUND

CUTS OR SLASHES
wound is longer than it is deep
the assailant strikes out with a swiping action,
rather than the thrust of a stabbing attack.
swung at arms length in a horizontal arc so that
if it contacts a body it will slice the skin and
tissues as it passes by.
SUICIDE : wrist or throat

INCISED WOUND

CUTS OR SLASHES
such injuries tend to dig in near the point of first
con- tact and become progressively more
shallow as the wound approaches the distal end.
superficial tail
less dangerous ; less likely to affect vital organs
NECK* : most dangerous

INCISED WOUND

STAB WOUND
an incised wound that is deeper than it is wide.
KNIVES, scissors, chisels, swords, open razors,
sharpened screwdrivers, spiked instruments,
glass

INCISED WOUND

STAB WOUND
characteristics:
wound will have gaped across the centre, to
form a long ellipse > gently opposed edges
and measure again
edge of weapon : V-point does not
necessarily indicate two sharp edge
stop full extent : a hilt bruise or abrasion on
the skin surrounding the wound.

INCISED WOUND

STAB WOUND
characteristics:
movement
dept
direction : from autopsy
estimation of force : is subjective and
cannot be quantified

INCISED WOUND

STAB WOUND FROM GLASS

most common weapons
a shallow slice which bleeds profusely
in a hairy area such as the scalp, it will
reveal cut hair bulbs on the shelved surface.
The sliver may break off and remain in a deep
wound
invariably radio-opaque

INCISED WOUND

STAB WOUND FROM SCISSORS

most common in woman uses a weapon upon
her husband
differ according to whether the scissors were
used open or closed.
wound made by closed scissors is typically
shaped like a flat Z

INCISED WOUND

DEFENCE WOUND
medico-legal significance
the victim was conscious, at least partly mobile
and not taken completely by surprise.
forearms and hands
instinctively raised to protect the eyes, face and
head.
thighs
shield the genitals.

INCISED WOUND

DEFENCE WOUND
medico-legal significance
the victim was conscious, at least partly mobile
and not taken completely by surprise.
forearms and hands
instinctively raised to protect the eyes, face and
head.
thighs
shield the genitals.

reconstruction

organ
severity
land mark

-
=> ()

, ,

deformity

vascular injury

vascular injury

PHASE OF WOUND HEALING

FACTORS AFFECTING WOUND HEALING

SYSTEMIC
AGE
OXYGEN
TRAUMA

METABOLIC DISEASE
IMMUNOSUPPRESSION
CONNECTIVE TISSUE
DISORDER
NUTRITION

AGE

aging produces intrinsic physiologic changes

that result in delayed or impaired wound
healing
collagen synthesis is not impaired with
advanced age
noncollagenous protein accumulation
at wounded sites is decreased with
aging

FACTORS AFFECTING WOUND HEALING

SYSTEMIC
AGE

OXYGEN

OXYGEN
TRAUMA
METABOLIC DISEASE
IMMUNOSUPPRESSION

CONNECTIVE TISSUE
DISORDER
NUTRITION

Low oxygen tension has a profoundly

deleterious effect on all aspects of wound
healing.
Fibroplasia, collagen synthesis
HCT < 15%, cardiac failure, local
vasoconstriction

FACTORS AFFECTING WOUND HEALING

SYSTEMIC
AGE

METABOLIC DISEASE

OXYGEN
TRAUMA

METABOLIC DISEASE
IMMUNOSUPPRESSION
CONNECTIVE TISSUE
DISORDER
NUTRITION

Diabetes mellitus reduced inflammation,

angiogenesis, and collagen synthesis.
contributes to local hypoxemia
Defects in granulocyte function,
capillary ingrowth, and fibroblast
proliferation
Uremia decreased wound collagen synthesis
and breaking strength
Obesity : Increased subcutaneous fat

FACTORS AFFECTING WOUND HEALING

SYSTEMIC

IMMUNOSUPRESSION

AGE

OXYGEN
TRAUMA
METABOLIC DISEASE

IMMUNOSUPPRESSION
CONNECTIVE TISSUE
DISORDER
NUTRITION

reduce collagen synthesis and wound

strength
inhibit the inflammatory phase of wound
healing and the release of lysosomal
enzymes
inhibit epithelialization and contraction and
contribute to increased rates of wound
infection

FACTORS AFFECTING WOUND HEALING

SYSTEMIC
AGE
OXYGEN
TRAUMA
METABOLIC DISEASE
IMMUNOSUPPRESSION
CONNECTIVE TISSUE
DISORDER

NUTRITION

NUTRITION

Poor nutritional intake or lack of individual nutrients

significantly alters wound healing
Low protein diet impaired collagen deposition with
a secondary decrease in skin and fascial woundbreaking strength and increased wound infection
rates.
enhanced rates of wound complications and
increased wound failure
reduced cell-mediated immunity, phagocytosis, and
intracellular killing of bacteria by macrophages and
neutrophils during protein-calorie malnutrition

FACTORS AFFECTING WOUND HEALING

SYSTEMIC
AGE
OXYGEN
TRAUMA
METABOLIC DISEASE
IMMUNOSUPPRESSION
CONNECTIVE TISSUE
DISORDER

NUTRITION

NUTRITION

FACTORS AFFECTING WOUND HEALING

SYSTEMIC

NUTRITION

AGE
OXYGEN
TRAUMA
METABOLIC DISEASE
IMMUNOSUPPRESSION
CONNECTIVE TISSUE
DISORDER

NUTRITION
Ratios of 14-day to 7-day values for aspartate (ASP), hydroxyproline
(OHP), lysine (LYS), and -amino nitrogen (AN) in volunteers given
dietary supplements of arginine, -hydroxy--methylbutyrate, and
glutamine. *P < .05. (Reproduced with permission from Williams JZ,
Abumrad NN, Barbul A. Effect of a specialized amino acid mixture on
human collagen deposition. Ann Surg. 2002;236:369.)

FACTORS AFFECTING WOUND HEALING

LOCAL

MECHANICAL INJURY

INFECTION
EDEMA
ISCHEMIA
TOPICAL AGENTS
RADIATION
FOREIGN BODY

INFECTION
breaches of the intact epithelium allow
bacteria access to these tissues and the
bloodstream.
The source of pathogens for the infection is
usually the endogenous flora of the
patients skin, mucous membranes, or
from hollow organs.
The presence of bacteria in an open
wound, either acute or chronic, does not
constitute an infection

FACTORS AFFECTING WOUND HEALING

LOCAL

MECHANICAL INJURY

INFECTION
EDEMA
ISCHEMIA
TOPICAL AGENTS
RADIATION
FOREIGN BODY

INFECTION
breaches of the intact epithelium allow
bacteria access to these tissues and the
bloodstream.
The source of pathogens for the infection is
usually the endogenous flora of the
patients skin, mucous membranes, or
from hollow organs.
The presence of bacteria in an open
wound, either acute or chronic, does not
constitute an infection

CASE STUDY I

WOUND

CASE STUDY I

1.
2.

case1

case1

case1

case1

case1

case1

case1

case1

CASE STUDY I
1.

3.

8.

3 4 .

CASE STUDY I
1.

3 .

1.5.
3 .

1.

3.

4.

CASE STUDY I
1.

3.

2.

4.

CASE STUDY I
1.

1-2

CASE STUDY I
2.

2.

CASE STUDY II

WOUND

CASE STUDY II
25

3


1

1.
2.

case2

case2

case2

case2

case2

case2

case2

CASE STUDY II
1.

1 4 20

1-2

1
3

2
3
3

CASE STUDY II
1.

CASE STUDY II
1.

CASE STUDY II
2.


Blunt force injury
(abrasion wound)
(contusion wound)
(laceration wound)
Sharp force injury
(stab/penetrating wound)
(cut/sharp wound)
( chop )
(gunshot wound)

Blunt force injury

1. Blunt force injury

3

1. Abrasion

Sliding abrasion ()

Pressure abrasion ()

2. Contusion
3. Laceration

1.1 Abrasion ()

 2
Sliding abrasion ()
Pressure abrasion ()

Sliding abrasion ()

Pressure abrasion ( )

1.2 Contusion ()

Cirrhosis ,
Coagulopathy




1.
2.

,,

2-3

,,

3-4

,,

5-7

,,

7-10

,,

10-12

,,

1.3 Laceration ()

Sharp force injury

2. Sharp force injury

2.1
(Stab/Penetrating incised wound)

 reconstruction

=
=

organ blood loss


2.2
(cut or incised wound)

(shearing)

( bridging tissue)

7

6-8

2.3 (Chop wound)

laceration wound
chop wound laceration wound
bone groove
bone


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

CAUSE OF DEATH

CAUSE OF DEATH

1.

shock
shock
15-20%
30-50%

2.




hemothorax
pneumothorax

3. (Embolism)

4.

Case 3
..

..

..

Case 3
45

2

2
1

1.
2.
3.

4.

case3

case3

case3

case3

1

1
1 2




1 1

- /
-

Suicide

Homicide

Suicide

Homicide

Hesitation mark


(Gun shot wound)
(Shot gun wound)

 (Gun shot)
4
1. (Bullets) :

2. (Artridge case):

3. (Propellants):
4. (primers):

 (Gun shot)

(Rifle)

(Pistol)

 (Gun shot)
( revolver)

(handgun)
single shot pistol

 (Gun shot wound)

(Entrance wounds)

- 90

-
-

 (Gun shot wound)

-

(star shape or satellite shape wound)
- (abrasion collar or marginal

abrasion)
- (grease ring)
-

 (Gun shot wound)

Contact shot wound ()
Closed shot wound ()
Distant shot wound ()

 (Gun shot wound)

Contact shot wound ()
(soot)
(Gun powder)

(Muzzle imprint)

 (Gun shot wound)

Closed shot wound ()

(Stippling or Peppering)

(soot)

 (Gun shot wound)

Distant shot wound ()
(soot)
(Gun powder)

 (Gun shot wound)

( exit wound )

Shotgun Wound

Shotgun wound

Shotgun


(Shotgun wound)


1-5


8 - 3

Manner of death

/


- ()

- (
)

Manner of death
Suicide
Homicide
Accident

Manner of death

-
-

1. -

2.

3.

4.

Suicide VS Homicide
Suicide

Homicide

Suicide VS Homicide
Suicide

Homicide

Hesitation mark

1.5

(reloaded)

(Motor area)
(Cadaveric spasm)

()

) 25%(
76%) 69%


SUICIDE

- Rt.temporal

- Rt.Parital

- Neck

- Mid.frontal

- Lt.temporal

- Rt.face

- Mouth

- Lt.parietal

HOMICIDE

- Rt/Lt.face

- Rt/Lt oral region

- Neck

- Rt/Lf. Temporal

- Rt/Lf. Parital

- Mid. Frontal

- Lip

- Occipital

- Submental

- Orbit

- Mounth

- Eyebrown

- Nose


Tight contact
Contact
Close range

Suicide
51.26%
42.55%
6.39%

Homicide
8.78%
28.07%
63.15%


Angle of elevation
Angle of
depression
Horizontal

Suicide

Homicide

76.59%
14.80%

14.03%
35.10%

8.6%

50.87%