/OPEN WOUNDS:

^Abrasion (Scratch, Graze, Impression Mark, Friction Mark):

[it is an injury characterized by the removal of the superficial epithelial layer of
the skin caused by a rub or friction against a hard rough surface.! Whenever,
there is forcible contact before friction occurs, there may be contusion associated
with abrasion. The shape varies and the raw surface exudes blood and lymph
which later dries and forms a protective covering known as scab or crust.

Abrasions Characteristics of
Abrasion:
a. ft develops at the precise point of impact of the force causing it.
b. Grossly or with the aid of a hand lens the injury consists of parallel linear
injuries which are in line with the direction of the rub or friction causing it.
c. It may exhibit the pattern of the wounding material.
MEDICO-LEGAL 261 d. It is usually ignored by the attending
physician for it does not require medical treatment but it has far-reaching importance
in the medico-legal viewpoint.
(1) Abrasions caused by fingernails may indicate struggle or assault and are
usually located in the face, neck, forearms, and hands.
(2) Abrasions resulting from friction on rough surfaces, either intentional or
accidental are located on bony parts of the body and usually associated with
contusion or laceration.
(3) Nature of the abrasion may infer degree of pressure, nature of the rubbing
object and the direction of movement.
 ASPECTS OF PHYSICAL INJURIES
e. Unless there is a supervening infection, abrasion heals in a short time and leaves no
scar. If the whole thickness of the skin is involved, healing may be delayed and
occasionally with scar formation.

Torms of A brasion: a. Linear:

\MOA
An > abrasion which appears as a single line. It may be a straight or curved line.
Pinching with the fingernails will produce a linear curved abrasion, while sliding the
point of a needle on the skin will produce a straight linear abrasion.
b. Multi-Linear:
An abrasion which develops when the skin is rubbed on a hard rough object
thereby producing several linear marks parallel to one another. This is frequently
seen among victims of vehicular accidents.
c. Confluent:
An abrasion where the linear marks on the skin are almost indistinguishable on
account of the severity of friction and roughness o the object.
d. Multiple:
Several abrasions of varying sizes and shapes may be found in different parts of
the body.
Types of Abrasions: a. Scratch:
This is caused by ajsharp-pointed object which slides across the skin, like a pin,
thorn or fingernail. The injury is always parallel to the direction of slide. The
commencement and termination are well defined and the depth depends on the
pressure applied. The fingernail scratch may be broad at the point of
commencement and may terminate with a tailing.
 ASPECTS OF PHYSICAL INJURIES
LEGAL MEDICINE

b. Graze:
These are usually caused by forcible contact with rough, hard objects
resulting to irregular removal of the skin surface. The nature of the injury is
dependent upon the degree of roughness of the object and the amount of pressure
in the course of the sliding. The course will be indicated by a clean
commencement and tags on the end.
c. Impact or Imprint Abrasion (Patterned Abrasion, Stamping Abrasion, "Abrasion A
La Signature"):
Those whose pattern and location provides objective evidence to show cause,
nature of the wounding material or instrument and the manner of assault or
death.
(1) Marks of the grid of the radiator may be imprinted on the skin.
(2) Tire thread marks may be seen on the skin in vehicular accidents.
(3) Muzzle imprint in contact fire gunshot wound of entrance.
(4) Teeth impression mark in skin bites.
d. Pressure or Friction Abrasion:
Abrasion caused by pressure accompanied by movement usually observed in
hanging or strangulation. The spiral strands of the rope may be reflected on the
skin of the neck. The lesion may dry up and assume a papyraceous or

. ~ , ,, ^ —. . .

parchmentlike consistency.
 ASPECTS OF PHYSICAL INJURIES
Abrasion in the form of tire marks in a victim of vehicular accident

MEDICO-LEGAL 263

Differential Diagnosis:
a. Dermal Erosion — A gradual breakdown or very shallow ulceration of the skin
which involves only the epidermis and heals withour scarring. It may appear in
spots and with no previous history of friction or sliding.

b. Marks of Insects and Fishes Bites — The skin injury is irregular with no vital
reaction and usually found on angles of the mouth, margins of nose, eyelids and
forehead.
c. Excoriation of the Skin by Excreta — This condition is only found among infants
and the skin lesion heals when the cause is removed. There is no apparent
history of rubbing trauma on the affected area.
d. Pressure Sore — Usually found at the back at the region of bony prominence.
History of long standing illness, bed ridden condition although pressure sore
may start as a previous area of abrasion.
^Distinction Between Ante-mortem from Post-mortem Abrasions:
Point of Ante-mortem Post-mortem Abrasion
Distinction Abrasion Yellowish and
Color Reddish-bronze. in appearance translucent in
due to slight exudation of blood. appearance.
Any area.
Location Generally occurs over bony
prominence, such as elbow,
and attributed to rough
handling of the cadaver.
With intravital reaction Shows no vital reaction and is
Vital reaction and may show remains of damaged characterized by a separation
epithelium. of the epidermis from complete
loss of the former.

2. Incised Wound (Cut, Slash, Slice):

This is produced by a sharp-edged (cutting) or ^sharp-linear edge of the
instrument, like a knife, razor, bolo, edge of oyster shell,' metal sheet, glass, etc. It
may be an impact cut when there is
forcible contact of the cutting instrument with the body surface, or slice cut when
cutting injury is due to the pressure accompanied with movement of the
instrument.
When the wounding instrument is a heavy cutting instrument, like axe, big
bolo, saber, the wound produced is called Chopped or LEGAL MEDICINE
 ASPECTS OF PHYSICAL INJURIES
Hacked wound. The injury is quite severe, edges may or may not be contused
depending on the nature of the edge of the instru-
ment used.
Characteristics of Incised Wound:
a. Edges are clean- both extremities are sharp, except in areas where the skin is loose
or folded at the time of infliction.
b. The wound is straight and may be shelving if inflicted with the wounding
instrument applied with an acute angle to the surface of the body involved.
c. Usually the wound is shallow near the extremities and deeper at the middle
portion. However, this finding may be modified by the shape of the wounding
instrument and part of the body involved.
d. Because the blood vessels involved are clean-cut, profuse he-morrhage is
invariably a feature.
e. Gaping is usually present due to the retraction of the edges but Its presence and
degree of retraction depends on the direction of the incised wound with the line of
cleavage (Langer's line).

f. If the incised wound is located in parts of the body covered with clothes, the
clothing itself will show clean-cut of its texture.

g. In the absence of complication and/or when there is deeper involvement present,

healing is relatively fast and the scar may not or may develop conspicuously.
h. Incised wound caused by broken edge of glass may be irregular and may appear
like a punctured or stab wound. Fragments of the glass may be removed from the
incised wound. Examination with the aid of a magnifying lens is necessary to
determine the presence and removal of particles of flakes of glasses in the wound.

Changes that occur in an Incised Wound:

After 12 hours — Edges are swollen; adherent with blood and with leucocyte
infiltration.
After 24 hours — Proliferation of the vascular endothelium and connective-tissue
cells.
After 36-48 hours — Capillary network complete; fibrolasts running at right angles
to the vessels.
After 3-5 days — Vessels show thickening and obliteration. (From: Gradwohl's Legal
Medicine by F.E. Camps ed., 3rd ed., p. 272).

MEDICO-LEGAL 265
 ASPECTS OF PHYSICAL INJURIES

Multiple Incised wounds (Homicidal).

Deep incised wound may cause clean-cut fracture of the bone, severance of
blood vessels and nerves or amputation. Paralysis may develop on account of the
severed nerve and profuse hemorrhage may result to death. Embolism or
supervening infection may later develop.
^ Why a Person Suffers from Incised Wound:
a. As a therapeutic procedure — Pyogenic abscess and cystic conditions may be
treated by incision.
b. As a consequence of_self-defense — The sharp-edged instrument may be held
by the victim in his attempt to avoid the offender to inflict more serious injuries
on him.
c. Masochist may self-inflict incised wound as a means of sexual gratification.
d^Addicts and mental patients may suffer from incised wound irrationally.
Incised Wounds may be Suicidal, Homicidal or Accidental:
Suicidal — Located in peculiar parts of the body, like the jjeck, flexor surfaces
of the extremities (elbow, groin, knee), wrist, and accessible to the hand in
inflicting the injury. The most common instrument used is the Jaarber's razor
blade with an improvised handle. There is usually superficial tentative cut
(hesitation cuts) and the direction varies with the location and the hand (left or
right) used in inflicting the injuries. The most
266 LEGAL MEDICINE

common site of suicidal incised wounds are on the wrist with involvement of
the radial artery and the neck.
^Homicidal — The incised wounds are deep, multiple and involve both accessible
and non-accessible parts of the body to the hands of. the viGtim. "defense and
other forms of wounds may be present. Clothings are always involved.
ytil Accidental — Multiple incised wound isjoommonly observed on the passengers
and _driver of vehicular accidents on account of the broken windshield and
glass parts of windows. Stepping on oyster shell, broken glassesTsharp edges
of metal sheets are common causes of incised wound on the sole of the foot.
Those associated in the use of kitchen knives in the preparation of food,
carpenters and handicraft workers who use sharp edged instruments are
frequent victims of accidental incised wounds.
Distinction Between Suicidal and Homicidal Cut-throat
Suicidal prove suicide.
Direction Oblique, from* Below left ear,
downwards, .across front ^ e c k Homicidal Usually
just .above horizontal below tho
Adam's apple. "Adam's'apple.

Severity Usually _noi_so deep and may

only involve trachea carotid Usually deep and may cause
and sometimes the esophagus is
involvement of the cartilage
involved.
and bones.
Superficial Usually present before
Cut the commencement of deeper Practically jibsent but
wound.
may rarely be
Position May be__sjtting facing a of the mirror
or standing, present when the
body victim struggled when
Wounding Firmly grasped (Cadaveric attacked. Usually victim _lying
weapon spasm) or found lying beside on bed or in other place.
victim. Weapon is jjbsent.
Blood Blood found in front part
distri- of the body. Hand gen-
bution erally smeared with Blood found at the back of the
blood. neck. JIands clean.
Motive History of mental depression,
domestic, financial social
problems, alcoholism etc. may
Absence of such history.
MEDICO-LEGAL ASPECTS OF PHYSICAL INJURIES