TYPES OF

WOUNDS
Ali, Norjamela M.
TYPES OF WOUNDS (Medical
Classification)
1.) CLOSED WOUND- no breach of continuity of the skin or mucous
membrane
a.) Superficial- when the wound is underneath the layers of the skin o
mucous membrane
1.) Petechiae- circumscribed extravasation of blood in the
subcutaneous tissue or underneath the mucous membr
Ex: mosquito bite, blood disease, hanging
2.) Contusion- effusion of blood into the tissues underneath the skin
on account of the rupture of the blood vessels as a result of the
application of blunt force or violence
3.) Hematoma- the extravasation or effusion of blood in a newly formed
cavity underneath the skin
Factors influencing the Degree and Extent of
Contussion:
a) General condition of the victim
(b) Part of the body affected
(c) Amount of force applied
(d) Disease
(e) Age
(f) Sex
(g) Application of heat and cold
The distinction between ante-mortem and post-mortem contusions in an undecomposed body is that….

■ Ante-mortem bruising: there is swelling, damage to epithelium, extravasation, coagulation and

infiltration of the tissues with blood
■ post-mortem bruising: there are no such findings.
■ Distinction Between Contusion and Hematoma:

Contussion Hematoma

effused blood are accumulated in the interstices blood accumulates in a newly formed cavity
of the tissue underneath the skin underneath the skin

skin shows no elevation and if ever elevated, the skin is always elevated
elevation is slight and is on account of
inflammatory changes

puncture or aspiration with syringe of the lesion aspiration will show presence of blood and
no blood can be obtained subsequent depression of the elevated lesion
TYPES OF WOUNDS (Medical
Classification)
b.) Deep
1.) Musculo-Skeletal Injuries
i) Sprain- partial or complete disruption in the continuity of a muscular or ligamentous support of
a joint, due to a blow, kick, or torsion force
ii) Dislocation –displacement of the articular surface of bones entering into the formation of a joint
iii) Fracture- continuity of bone is broken due to violence or existing pathology
(a) Close or Simple- no break in continuity of the overlying skin
(b) Open or Compound — The fracture is complicated by an open wound caused by the broken
bone which protruded with other tissues of the broken skin.
(c) Comminuted — the fractured bone is fragmented into several pieces.
(d) Greenstick — A fracture wherein only one side of the bone is broken while the other side
is merely bent.
(e) Linear — When the fracture forms a crack commonly observed in flat bones.
(f) Spiral — The break in the bone forms a spiral manner as observed in long bones.
(g) Pathologic — Fracture caused by weakness of the bone due to disease rather than
violence.
iv) Strain- over-stretching instead of an actual tearing or the rupture of a muscle or ligament
v) Subluxation- Incomplete dislocation
Closed Wound
ii) Deep

2.) Internal Hemorrhage- rupture of blood vessel which may cause hemorrhage
may be due to the following:
(a) Traumatic intracranial hemorrhage
(b) Rupture of parenchymatous organs
(c) Laceration of other parts of the body
3.) Cerebral Concussion (Commotio Cerebri)
-stunning of the brain char. by more or less complete suspension of its functions as a result of
injury to the head, which leads to some commotion of the cerebral substance
-more severe when the moving o rmobile head struck a fixed hard object
compared when the head is fixed and struck by a hard moving object
Signs and Symptoms of Cerebral Concussion:

(a) Unconsciousness which is more or less complete.

(b) Muscles are relaxed and flaccid.
(c) Eyelids are closed and the conjunctivae are insensitive.
(d) Surface of the body is pale, cold and clammy.
(e) Respiration is slow, shallow and sighing.
(f) Pulse is rapid, weak, faltering and scarcely perceptible to the fingers.
(g) Temperature is subnormal.
(h) Sphincters are relaxed perhaps with unconscious evacuation of the bowel and bladder.
(i) Reflexes are present but sluggish and in severe cases may be absent.
TYPES OF WOUNDS (Medical
Classification)
2.) OPEN WOUND- there is a breach of continuity of the skin or mucous
membrane.
a.) Abrasion
b.) Incised Wound
c.) Stab Wound
d.) Punctured
e.) Lacerated
Abrasion ( Scratch, graze, impression mark, friction mark)
-injurycharacterized by the removal of the superficial epithelial layer of the
skin caused by a rub or friction against a hard rough object
* Contusion w/ abrasion= forcible contact before friction occurs
* The shape varies and the raw surface exudes blood and lymph which later dries and
forms a protective covering known as SCAB or CRUST
Characteristics of Abrasion:

a. It 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.

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.

* Abrasions caused by fingernails may indicate struggle or assault and are usually located in the face, neck,
forearms, and hands.

* 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.

* Nature of the abrasion may infer degree of pressure, nature of the rubbing object and the direction of
movement.

e. Heals in a short time and leaves no scar if not infected

*If the whole thickness of the skin is involved, healing may be delayed and occasionally with scar formation.
Forms of Abrasion:
a. Linear- appears as a single line, straight or curved
* pinching with the fingernails= linear curved abrasion
* sliding the point of a needle on the skin= straight linear abrasion
b. Multi-Linear- develops when the skin is rubbed on a hard rough object producing several linear
marks parallel to one another
*Ex: Vehicular accident victims
c. Confluent- linear marks on the skin are almost indistinguishable on account of the severity of
friction and roughness of the object
d. Multiple- Several abrasions of varying sizes and shapes may be found in different parts of the
body.
TYPES OF ABRASION
a. Scratch: caused by a sharp-pointed object which slides across the skin, like a pin, thorn or
fingernail.
* Injury is always parallel to the direction of slide.
* Fingernail scratch may be broad at the point of commencement and may terminate with
a tailing
b. Graze: caused by forcible contact with rough, hard objects resulting to irregular removal of the skin
surface.
* 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.
* Ex: Tire thread marks seen on the skin in vehicular accidents.
d. Pressure or Friction 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.
Antemortem Abrasion vs. Postmortem Abrasion

ANTEMORTEM ABRASION POSTMORTEM ABRASION

COLOR Reddish-bronze due to slight Yellowish and transparent
exudation of blood
LOCATION Any Area Over bony prominence
Assoc. w/ rough handling of the
cadaver
VITAL REACTION w/ intravital reaction Shows no vital reaction
May show remains of damaged and is characterized by a
epithelium separation of the epidermis
from complete loss
of the former
Incised Wound (Cut, Slash, Slice)-produced by a sharp-edged (cutting) instrument
like a knife, razor, bolo,
*Impact cut : when there is forcible contact of the cutting instrument with the body surface
*Slice cut: when cutting injury is due to the pressure accompanied
with movement of the instrument.
* Chopped or Hacked wound: when the wounding instrument is a heavy cutting instrument like
axe, saber
Characteristics of Incised Wound
1. Edges are clean
2. The wound is straight
3. Usually the wound is shallow near the extremities and deeper at the middle portion
4. Profuse haemorrhage because of the clean-cut on the blood vessels
5. Gaping is usually present due to the retraction of the edges
6. Clothes will also show a clean cut if cut by the instrument.
7. Faster healing if without complications
8. Incised wound made by broken glasses maybe irregular, needs to be removed
Changes that occur in an Incised
Wound:
1.) After 12 hours — Edges are swollen; adherent with blood and with leucocyte
infiltration
2.) After 24 hours — Proliferation of the vascular endothelium and connective-tissue cells
3.) After 36-48 hours — Capillary network complete; fibroblasts running at right angles to
the vessels
4.) After 3-5 days — Vessels show thickening and obliteration
Why a person suffers from incised wound:

1.) As a therapeutic procedure

2.) As a consequence of self-defense
3.) Masochist may self-inflict incised wound for self-gratification
4.) Addicts and Mental Patients
Incised Wounds may be Suicidal, Homicidal or Accidental:

Suicidal — Located in peculiar parts of the body and accessible to the hand
*most common site: wrist, radial artery and the neck.
Homicidal — Deep, multiple and involves both accessible and non-accessible parts of the body to the
hands of.
* Clothings are always involved
* Defense and other forms of wounds are present
Accidental — Multiple incised wound observed on the passengers and driver of vehicular accidents
due to broken windshield and glass parts of windows.
*kitchen knives in the preparation of food, carpenters and handicraft workers who use sharp
edged instruments
 Suicidal Wounds Homicidal Wounds
Direction Oblique from below left ear, Usually horizontal below the
Downwards across front neck Adam’s apple
just above Adam’s apple
Severity Usually not so deep & may only Usually deep and and may cause
involve trachea, carotid and involvement of the cartilage and
esophagus bones
Superficial Cut Usually present before the
commencement of deeper wound
Position of the Body May be sitting or facing a mirror
or standing
Wounding Weapon Firmly grasp (cadaveric spasm) Weapon is absent
or found lying beside the victim
Blood Distribution Blood found in front part of Blood found at the back of the
body. neck.
Hand smeared with blood Hands are clean
Motive History of mental depression, Absence of such history
financial, social problems,
alcoholism
Previous History of May be present Always absent
Self- Destruction
STAB WOUND-is produced by the penetration of a sharp-pointed and a
sharp edged instrument like a knife, dagger, scissors

■ Incised wound-If the sharp edge portion of the wounding instrument is the first to come
in contact with the skin,
■ Stab wound- If the sharp-pointed portion first come in contact
The depth may be influenced by:
1.) size and sharpness of the instrument
2.) area of the body involved
3.) the degree of force applied
How to describe stab wound:

a. Length of the skin defect — The edges must be coaptated first

tailing - the direction of withdrawal of the wounding weapon
b. Condition of the extremities
sharp extremity =sharpness of the edge of the instrument used.
c. Condition of the edges
* one stabbing- the edges are regular and clean-cut.
* several stabbing acts (series of thrusts and withdrawal)-edges may be serrated or zigzag in appearance.
d. Linear direction of the surface wound — It may be running vertically, horizontally, or upward medially or
laterally.
e. Location of the stab wound — must include measurement to some anatomical landmark
f. Direction of penetration —must be tri-dimensional
g. Depth of the penetration.
h. Tissue and organs involved
Stab wounds may be:
A.) Suicidal
1.) Located over the .vital parts of the body.
2.) Usually solitary.
3.) If located on covered parts of the body, the clothings are not involved.
4.) Stab wound is accessible to the hand of the victim.
5.) Hand of the victim is smeared with blood.
6.) Wounding weapon is firmly grasped by the hand of the victim (cadaveric spasm)
7.) If stabbing is accompanied with slashing movement
* wound tailing abrasion is seen towards the hand inflicting the injury
8.) Suicide note may be present.
9.) Presence of a motive for self-destruction.
10.) No disturbance in the death scene w/ wounding instrument found near the victim.
B.) Homicidal — Stabbing with homicidal intent is the most common
Characteristics:
(1) Injuries other than stab wound may be present
(2) Stab wound may be located in any part of the body
(3) Usually there are more than one stab wound
(4) Motive for the stabbing.
* If without, the offender must be insane or under the influence of drugs.
(5) Disturbance in the crime scene