The following is an extract taken from “Sexual Assault Examiner Training

BMSC X 466” – Lesson 2 – Forensic Classification of wounds. University of

California, Riverside, University Extension.

Forensic Classification of Wounds

The forensic pathologist classifies wounds according to the mechanism causing
them: either the skin and underlying structures are sharply divided or cut by
any sharp edge or pointed weapon—all tissues are cut evenly in the weapon’s
path; or a blunt force crushes, tears, and shears tissues, at times leaving those
tissues of varying tensile strength (certain blood vessels, nerves, tendons)
intact and “bridging” across the wound. These wounds are classified by the two
categories:

I. Wounds caused by sharp-edged, pointed weapons: (such as broken glass,

knives, ice picks, barbecue fork or any sharp edge).

II. Those caused by blunt-force trauma: (usually a heavy object with smooth
or blunt edges) which injures by its weight and/or the force impacting the
victim or the force with which the victim strikes the blunt object. If both the
victim and the blunt object are in motion when they impact even greater injury
results because of the velocity at which each surface is moving—this is seen in
vehicular crashes.

Whether the wound is accidental or purposefully produced, it is classified by

the mechanism causing injury.

Examples of blunt objects include the baseball bat, a rock, unbroken bottle,
fist, vehicle tire, etc.

Sub-categories of Wounds Caused by Sharp-edged, Pointed Weapons

Incised Wound #1 ( 174068 Bytes )
Stab Wound #1 ( 137257 Bytes )
Stab Wound #2 ( 117381 Bytes )
• Incised wound or cut Wherein the sharp edge is drawn across the skin
resulting in a wound that is longer on the skin than it’s depth within the body.
The mechanism of injury is a sharp edge which cuts all tissue in its path as it
penetrates the skin: usually the wound edges are sharply delineated and there
are no cross strands of tissue within the wound (known as “bridging.”)

• Stab wound The pointed, sharp edge may cut surface tissue, but the depth of
the wound is longer than the width of the wound. The danger lies with the
unknown depth of the wound and what underlying structures may have been
nicked or cut. The wound track may be much deeper than the alleged weapon
found, since the force of the thrust of the weapon and the great stretching
tensile strength of skin permit deeper penetration. The same weapon can cause
both incised and stab wounds.

• Puncture Wound The wound in caused by a pointed object such as a needle,

fork, ice pick, etc.
Abrasions
When a body slides across a rough surface the friction created mechanically
injures superficial epidermal and dermal cells, denudes the epidermis and
dermis and may include rupturing some superficial blood vessels underneath.
Lay people call these “scrapes” or “friction burns”. Tissue fluid and blood may
be exuded which dries and crusts, and turns dark brown and is called a
“scab.” Linear abrasions are termed “scratches.” These usually heal without
scarring. In the deceased body, these abraded areas where tissue fluid has
exuded dries and turn reddish-brown or brown.

Tissue rubbing against tissue can also cause a friction abrasion.

• Impact Abrasion
If an object is pressed onto the skin with enough force and results in relatively
minor injury to the epidermal and dermal cells and rupture of blood vessels, a
mirror image of the object in the form of redness can be seen often in the
superficial layers of the skin. These are different than the erythema or redness
caused by congested blood vessels that appear on the victim’s body in the form
of a reddened handprint or finger marks around the neck resulting from
restraint or attempted manual strangulation; these disappear within hours and
leave no residual marks.

• Contusions
A contusion (bruise) signifies hemorrhage into the skin, the tissues under the
skin or both. It is usually the result of a blow or squeeze that crushes the
tissues and ruptures the blood vessels but does not rupture the skin. Some
bruises are patterned because of their design or shape; others are patterned by
their location, distribution, and relationship of one bruise to another.
Recognition of the pattern may help to reconstruct the circumstances of injury.
If a victim dies soon after injury, there may not appear any mark on the
surface of the skin; the forensic pathologist makes an incised wound over the
suspect area to see if extravasated blood lies underneath. In the living victim, it
may take from 24 hours to days for the bruised area to appear on the skin.

• Patterned Contusion
Less well-known are the two, parallel train track-like lines or tramline of
hemorrhage that result from a blow with a rod, stick or whip. Many times there
will be an area of sparing at the site of the impact and the bruise will surround
it, due to the displacement of the tissue and blood at impact. The skin between
the lines remains intact because the blood is displaced sideways by the
pressure of the implement. The injured cells leak blood and tissue fluid into the
area causing bruising and swelling; the discoloration may last for days. It is
termed a “patterned contusion” because the bruising which results follows the
contour of the implement used—investigators will look for a possible object
which could cause that pattern at the crime scene.
Some clinicians call these blue or purplish-blue areas “ecchymoses,” but
hematologically speaking, ecchymoses are caused by an underlying medical
condition which results in the rupture of capillaries. Dorland’s Medical
Dictionary defines ecchymosis as “a small hemorrhagic spot, larger than a
petechiae, in the skin or mucous membrane forming a non-elevated, rounded
or irregular, blue or purplish patch.” Dorland’s, (2003), p 584. William’s
Hematology (2001) p 6 makes a similar distinction. Since the examiner may be
testifying in court and needs to clearly communicate to the jury (which is
generally considered to be of eighth-grade level of education), using the term
“bruise” is usually understood without explanation, where the unfamiliar term
“ecchymoses” requires elaboration and has to be used appropriately.

• Whether or not the imprint from a slap, strike by a bat, or bite mark will
disappear after a few minutes to hours or leaves a bruise that may last for days
is dependent on the degree of injury to the cells and blood vessels: if the blood
vessels are just congested, the area will show redness or erythema and will
disappear relatively quickly. If the cells are injured and tissue, fluid and blood
leak into the surrounding area, you may see bluish discoloration of the skin and
possibly swelling—a contusion. If superficial epidermal and dermal cells are
injured and denuded, such as occurs in an abrasion, tissue fluid which leaks out
of the injured cells forms an exudate which collects on the skin: it dries, crusts,
and takes several days to heal.

• Lacerations
When blunt force trauma squeezes or tears the skin and/or underlying
structures producing and open wound with bleeding, the wound is called a
laceration. The wound margins are usually jagged or irregular because the
tissue is split or torn but the blunt force and the margins may also be bruised.
Furthermore, "bridging" may be observed as the edges of the wound separate
and strands of tissue extend across the depth of the wound margins. Nerves,
elastic and connective tissue fibers and blood vessels have different tensile
strengths; with blunt force trauma some may remain intact while others are
severed; this is referred to as "bridging." If the blow occurs over a bony
prominence such as the skull there also may be undermining of tissue over the
bone. Sequelae of lacerations of internal organs such as the liver, spleen or
aorta with resultant hemorrhage can result in rapid death. Facial and scalp
wounds generally tend to bleed more profusely than similar injuries elsewhere.

• Tear
subclassification of laceration When only the superficial layers of the epidermis
or dermis are injured by over-stretching of the skin of the genital or anal area,
the wound is commonly called a “tear,” and may or may not bleed. Because
elderly women have de-estrogenized genital tissue the skin is very fragile. How
many nurses have inadvertently caused a tear of the posterior fourchette of an
elderly woman by wiping the area with antiseptic-soaked cotton balls in
preparation for catheterization? The erect penis combined with lack of vaginal
lubrication, a struggling victim and other factors, in a sexual assault, often
causes tears in the genital or anal area. This is the mechanism of most external
vaginal findings.

• Avulsion
An avulsion may be partial or total. This is when the blunt force tears off any
part of the body from the whole, such as a finger, tooth or scalp. An example
might be when a finger gets caught in a car door and the skin is pulled away,
exposing the bone. A degloving injury is a form of avulsion. Partial avulsion of
bones can occur. The complete loss of a digit, tooth or arm are examples of
complete avulsions.

• Fracture
[For photos of fractures refer to Gall, et al, (2003), pp. 42, 84 and 86]
A fracture is the partial or complete laceration of the bone. The bony area may
fragment into pieces like a cracked eggshell, referred to as a comminuted
fracture, as is often seen in head injuries such as the depressed skull fracture.
The long bones may be severed totally with no bone edge displacement (linear
fracture) or with displacement and smooth edges of the fracture or jagged ends.
Spiral fractures often occur when a long bone is twisted, such as occurs in
child abuse. The bone may be cracked but not displaced, termed a greenstick
fracture, which is common in the softer bones of children. Compression
fractures occur most commonly in the vertebrae where the vertebral body
collapses, especially common in the elderly. The danger in a fracture is what
structures the bony edges may penetrate or displace such structures as
arteries, nerves, or internal organs. As an example, displaced fractures of the
ribs may seriously compromise the pleural cavity, lungs, heart and great
vessels and result in death.

• Human Bite Marks

Human bite marks manifest themselves as an ovoid wound with an upper arch
and lower arch. The upper arch represents the upper jaw and the lower arch
represents the lower jaw. Often bite marks contain only partial imprints of an
upper or lower arch. Separate indentations may be made from the individual
teeth (impact abrasions) and often there is bruising in between the teeth marks
as the pressure, from the bite, forces the victim's flesh against the gaps
between the perpetrator's teeth. Lacerations may occur due to excessive force,
body area bitten, jagged teeth or resistance from the victim. Less than perfect
dentition and/or poor dental maintenance aid in making individualistic bite
patterns.

At times, a bite mark may appear as an ovoid redness or bruise, depending on

how much time has elapsed since infliction of the bite. Sites can be any place
on the body. Sexual assault victims are often bitten on the neck and breasts or
thighs.

The specialist, who determines if a specific bite mark was made the suspect, is
the Forensic Odontologist--a dentist who has received special training. Dental
impressions are taken from the suspect, and acetate overlays are made from
life-sized photographs of the bite mark. A special right-angled ruler (Odentology
Ruler-gray scale or ABFO ruler; see photo11) is placed on the skin next to the
bite, which indicates size (in millimeters) and whether or not the camera lens is
parallel to the patient's skin (by circles on the ruler--if the circle appears ovoid
it indicates that the photograph was taken at less than a 90-degree angle to the
victim's skin.) An analysis is made between the overlay and the dental
impression. The serial killer Ted Bundy was convicted on bite mark evidence.
As digital software programs are being developed, newer methods of examining
and recording bite-marks are being expanded.

The victim who presents to the emergency department with bite wounds should
not have the wound cleansed. The site should be swabbed for dried saliva for
potential DNA analysis. (See evidence collection, Lesson Four). The bite
wound(s) should be photographed to document the location of the bites,
preferably with an odontology ruler. p> • Patterned Injury
The term, “patterned injury,” is used when the object producing the wound
leaves an imprint or partial imprint, mirror or negative image of the offending
weapon. These are sometimes seen in incised and stab wounds as well as in
blunt force trauma and bullet wounds. Examples include: human bite marks;
ligature or handcuff impact abrasions; manual strangulation attempts; contact
or intermediate-range gunshot wounds. For purposes of documentation by the
examiner, it is not necessary to identify “patterned injuries”; one merely
describes the characteristics, color, size and placement of the marks one
observes.

Pearl: For the clinician, it is important to realize that areas of erythema must
be photo-documented at the time the victim presents, because they will soon
disappear. Contusions may not appear for several hours to days.
Photographing may best be accomplished at the time of exam and a day or so
after the exam to document the severity of the contusion.

Pearl: "Stellate" is the term given to star shaped patterned injuries that may be
caused by a bullet wound or anal tears in a sexual assault.