Anatomy of Wounds

Definition of a Wound
 (common definition) defined as damage to
any part of the body due to the application
of mechanical force.
 (legal definition) usually requires the
integrity of the body to be breached.
 Other jurisdictions grade wounds not by
their physical nature, but by the perceived
risk to health and life. (This can be
extremely difficult!)
Mechanism of Wounding

 The intensity of the force that creates

the wound obeys the usual laws of
physics.
 This can be surmised by saying, the
force of impact varies directly with the
mass of the weapon and directly with
the square of the velocity of impact.
 KE= (½mass)(velocity2)
Making sense of physics

 A one pound brick, placed against

the skull may not cause any
damage.
 The same brick thrown with a
velocity of 10 m/s may smash the
skull.
 Another factor to consider is the
area that the force impacts.
The Effect of Mechanical
Force
 The condition of the tissue impacted also
must be considered with the injury.
 Effect can cause:
 Compression
 Traction
 Torsion
 Tangential (shear)
 Leverage stresses
 But once the effect is known, it is essential
for pathologist to adequately describe the
actual wounds (especially for legal
purposes).
Describing Wounds
 It is essential for pathologist to
adequately describe wounds (especially
for legal purposes).
 The most useful classifications of wounds
are:
 Abrasions – grazes or scratches
 Contusions – bruises
 Lacerations – cuts or tears
 Incised wounds – cuts, slashes or stabs
Anatomy of the Skin
Abrasions
 Most superficial of wounds
 Typically thought of as one
that does not penetrate the
full thickness of the
epidermis
 Bleeding does sometimes
occur because of the
corrugated nature of the
dermal papillae.
 Known as scratches.
 Abrasions become leathery Simple abrasion of the skin caused
shortly after death. by an almost perpendicular impact
of the head against the ground.
There is only slight tangential
scuffing though most abrasions
have some element of sideways
contact that damages the
epidermis.
Tangential or Brush Abrasions
 Caused by lateral rubbing rather than
vertical pressure.
 Direction of force can often be noted in
the wound.

The epidermal tangs raised tend to pile

up at the distal end of the wound.
Peeling of Epidermal Layer

A linear abrasion
or “graze,”
confined to the
upper layers of
skin. The
tangential
direction of
impact of the
weapon was from
above
downwards.
Crushing Abrasions

 Involve vertical force to the skin

 Often imprints of weapon are left
in the skin
 Abrasions are typically depressed
unless swelling has occurred.
 Bruising under the dermis often is
present.
Fingernail Abrasions

 Important in child abuse cases,

sexual assaults, and manual
strangulation.
 Women are typically associated
with these abrasions.
 Upper arms are a frequent site for
gripping and restraint.
 Marks may be superimposed.
Fingernail Abrasions
Abrasion in manual
strangulation, the area is
more extensive than is
usually seen because of
sliding movements of
assailant’s hands.
Small marks are fingernail
abrasions.
Patterned Abrasions
 Patterned injuries
occur when the force
is applied at or near
a right angle to the
skin surface.

Victim struck in the head with a

heavy ashtray leaving an
imprint of the embossed
concentric circles molded into
the glass.
 Extensive abrasion of
the knees and shins of
a drunk who stumbled
along furniture before
falling and striking his
head and dying from
subsequent injury.

Abrasions found on the head of a

swimming pool attendant found
drowned in a shallow pool. The
abrasions matched the tiles lining
the pool, so it was concluded the
attended slipped and fell
unconscious into the water and
subsequently drowned.
 Patterned abrasions from the back edge of a
serrated knife. Measurements and photographs
with a scale should always be obtained to assist in
identification of the weapon.
 Contusions or Bruises
 Often combined
with abrasions.
 Pure bruises lie
beneath an intact
epidermis and
consist of an
extravascular
collection of blood
from damaged
blood vessels.
Intradermal Bruises
 Typically sharp
edged bruises that
do not continue to
the adipose tissue.
 Likely to occur when
the weapon has
alternating ridges
and grooves as the
skin is forced into Pattern Intradermal bruise showing
the grooves. shoe print pattern of rubber soles of
shoes on neck and T-shirt of a
homicide victim.
Kicking and stamping injury to the
face. The nose is bruised from a
kick and the patterned rubber sole
of the shoe has imprinted
intradermal bruising on the
forehead.

Extensive bruising of the face due to

hitting, kicking and stamping six days
earlier. The victim has multiple fractures of
facial bones.
 Bruising from a beating
with a broom handle. The
parallel lines indicated
impression by a square or
round weapon. The
pressure in the center
compresses the vessels so
that they do not bleed.
 Suction marks in the
left breast of a 22
year old homicide
victim who was
killed by manual
strangulation.
 Suction bruising is
common in sexual
assault cases.
This is an example of a patterned
abrasion of the abdomen by scraping
along a rough sooty and rusty surface of
a metal tank during a fall. The pattern
may give some indication of the nature of
the surface and the direction of the force.
Blunt trauma to the
head can be
suggested by scalp
contusions with
subgaleal collection
of blood, as shown
here. [Image contributed by
Todd Grey, MD, University of
Utah]
Kicking (resulting in bruising)

 Typically kicks to the torso leave

impressions that are readily
recognizable.
 Most kicks are delivered to victims
already lying on the ground.
 The major characteristic of most
kicking injuries is the severity of
bruising and underlying damage.
Lacerations
 The full thickness of the skin must be
penetrated to be considered a laceration.
 Different from incised wounds because the
continuity of skin is interrupted by pressure
rather than cutting.
 Bridging appears across the wound.
 Lacerations usually need underlying bone to
act as an anvil to tear the skin.
Lacerations

 A laceration can be distinguished

from an incised wound by:
 bruising or crushed margins
 bridging (presence of tissue strands
across wound)
 absence of a sharply linear injury
 If laceration is on scalp, hairs will
remain intact.
Here is a very superficial laceration of the forehead. Note
that the skin surface is broken. There are some small tags
of skin where the surface was irregularly torn.
Laceration of eyebrow with
surrounding bruising. The victim
fell from a low cliff onto rocks.
The sea has washed away the
original bleeding.

Multiple homicidal lacerations of the

scalp. The unusual shape is difficult
to interpret, but they were caused by
a claw hammer
 Homicidal lacerations of the scalp
penetrating the skull. Although some of
the injuries resemble incised wounds, their
margins are crushed, and hairs and tissue
strands cross the injuries.

Laceration caused by flashlight.

The skin is reddish due to burning.
The skin on the shoulders is
reddish due to first- and second-
degree burns.
Why does a laceration
sometimes appear to be a
incision?
When there is a crushing
impact of a blunt object on skin
supported by bone, such as a
scalp or skull cap, the skin is
sandwiched between weapon
and bone. This causes a
lacerated split that has bruised
margins and bridges of hair
and tissue in the wound.
Incised Wounds

 Injuries caused by sharp objects are

classified as ‘incised’ wounds, though the
nomenclature is again confused.
 Often times injuries cause with weapons
like axes or spikes are classified as incised
wounds, when in fact they have more
properties of lacerations.
 Can be classified further into cuts, slashes,
stab and puncture wounds.
Transection of a body into two halves at waist level. The
victim jumped from a high rise and landed on a fence.
 Incised Wounds
Here is an incised wound
of the skin of the hand. An
incision has clean, straight
edges made by a sharp
object such as a knife (or
in this case a rose thorn).
Lacerations are produced
from a more irregular
object and appear as
irregular broken areas.
Cuts or Slashes
 Classified as this because they are longer
than they are deep.
 Assailants strike out with a swiping motion
rather than a thrusting/stabbing motion.
 Common is gang, and bar-room brawls.
 Also commonly seen in cases of suicide on
the wrists.
 Typically they tend to be deepest at point
of first insertion and lessen in depth along
the length.
 Arms and face are common targets for
these types of wounds.
 A knife slash of the back showing
regular scratches along the margin.
This was inflicted with a “Rambo” knife,
which has deep serrations along the
back edge that have somehow marked
the skin on withdrawal.

Homicidal slash wounds caused by a

knife; the length is greater than the
depth, unlike stab wounds. The long
tails are due to the knife rising from
the skin, this indicating direction.
Stab Wounds

 Of major forensic importance

because of their high prevalence in
homicides.
 A stab wound is an incised wound

that is deeper than it is long.

 Often penetrates the viscera and

involves internal organs.

Nature of Stabbing Weapons
 Knives are the weapons most frequently
involved and their physical characteristics are
important in shaping the wound.
 When a pathologist examines a knife as a
possible murder weapon, he must note:
 the length, width and thickness of the blade
 whether it is single or double edged
 the degree of taper from the tip to hilt
 the nature of the back edge in a single-edged knife
 the face of the hilt guard adjacent to the knife
 any grooving, serration or forking in the knife
 the sharpness of the edge and extreme tip
Characteristics of Stab
Wounds
 The surface and internal appearances
of stab wound allow the pathologist
to offer an opinion upon:
 The dimensions of the weapon
 The type of weapon
 The taper of the blade
 Movement of the knife in the wound
 The depth of the thrust
 The direction of the thrust
 The amount of force used
Dimensions of the Weapon
 The dimensions of the weapon come into
critical importance in cases in which the
weapon is removed from the scene by the
assailant.
 The pathologist predictions can sometimes
aide the investigators in their search.
 Because of the elastic nature of the skin, one
must estimate the knife to be somewhat larger
than the wound is measured in situ.
Multiple stabs on the back from the same knife,
showing differing shapes and sizes.
Langer Lines

 Because of the orientation of

muscle fibers, the stab wound may
have much different appearances
even when the same blade is used.
 These lines are called langer lines.
 Stab wounds made in the direction
of the langer lines, appear slender
and long, those that transect line
appear wider.
A stab wound showing a unilateral
fish tail split cause by the blunt
back edge of the knife blade. This
is sometimes bilateral due to the
tearing of tissues. The other end of
the wound is sharp because of the
sharp edge of the weapon.
Movement of the Knife in the
Wound
 Significant movement may distort
wound shape and characteristics.
 Rocking can lengthen the wound.

 Pathologist often make predictions

based on the victim being static, so

it is vital to imagine the scenario in
a dynamic situation.
Multiple stab wounds
showing variation of size
and shape due to movement
of the blade and varying
force and direction.
 Forcible stabbing
can indent the
body surface so
that deep
structures can be
injured and make
the appearance
of the knife
larger.
 Multiple homicidal knife
wounds all inflicted
with the same weapon.
This shows the marked
variation in wound size
from the same knife,
cause by rocking and
twisting movements of
either weapon or
victim.
Estimating Force
 Many factors must be considered when
estimating amount of force required to
inflict the wound.
 Skin is tissue most resistant to knife
penetration.
 Sharpness of knife is most important factor
in penetration.
 Speed of approach is vital for penetration.
 Stretched skin is easier to penetrate than
lax skin.
 Knife penetrates skin rapidly.
 Cartilages are easily cut by knife.
 Homicidal stab wounds of
the throat and head
showing the variance of
injuries caused by the same
knife. The wound under
the chin is v shaped caused
by twisting of the weapon.
The larger wound is
consists of multiple thrust
super imposed over the
manubrium.
 Three wounds from a single stab with a knife, which was I place
when the body was discovered. The knife had entered obliquely
through the inner side of the right breast, emerged into the
cleavage and re-entered the mid line. If the knife had not been
in situ, interpretation could have been more difficult.
 Multiple
homicidal stab
and incised
wounds inflicted
with various
kitchen utensils.
Many of the
weapons were
left in place.
Injury from Scissors

 Often seen in domestic

disturbances.
 Shape of the wound will differ
based on whether the scissor was
used open or closed.
 Typically shaped like a Z
Profiles
 Here we see various profiles made by
scissors stabbed through the skin. The
cross shapes are cause by blade
screws or rivets; the one on the right is
a full penetration of one bland of an
open pair of scissors, the other blade
impinging flat on the skin
Defensive Wounds
 The natural reaction to any assault is self
defense, so defensive wounds are common.
 The most obvious are those seen in knife
attacks.
 Fingers, wrists, and forearms
 In attacks from blunt objects, bruises are the
hallmark of defense.
 They are common on the outer side of the
forearms hands wrists and backs of victims.
Various
defensive
incised wounds
on wrist and
hands.
A thought to ponder . . .

 Every pathologist must avoid the

cardinal sin of over interpretation.