THE IMPORTANT OF WOUNDS AND

DIFFERANTIAL DIAGNOSIS IN
FORENSIC PRACTICE

Dr. Ahmed Makata, MD, PhD, DFM(RCPA), FCPath (ECSA)

Senior Lecturer in Forensic Medicine
KIUT
 Outline
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Introduction
I. Medicolegal importance of abrasions
II. Medicolegal importance of bruises/contusions/hematoma
III. Medicolegal importance of lacerations
IV. Medicolegal importance incised wound
V. Medicolegal importance of stab wounds (Punctured Wound)
VI. Medicolegal importance of chop wounds (chop lacerations)
 Introduction
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Medicolegal Classification of trauma
 Depending on the causative factor, medico-legally trauma includes five
types and they are:

1. Mechanical
2. Thermal
3. Chemical
4. Electrical/lightning
5. Radiation.

 Mechanical trauma is most commonly encountered

 I. Medicolegal importance of abrasions
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 Can provide clues on site of impact and direction of force

 Can be the only external sign of a severe internal injury

 Can help to identify causative weapon, e.g. imprint abrasions

 Can help to determine time since injury

 Can help to assess the motive, e.g. ligature mark of hanging,

strangulation, etc
 Character and manner of injury can be known from its distribution

 Abrasions may also be developed on a cadaver (postmortem

abrasion).
 Bruise and time since injury
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 Differences between antemortem and postmortem
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abrasion
Features Ante-mortem Post mortem abrasions
abrasion
Site Anywhere on the body Usually over bony prominences
Colour Bright red or reddish Yellowish, translucent and
brown depending upon parchment like
the age of the injury
Exudation More and scab raised Less or no, scab often lies below
the level of the skin
Microscopy Vital reaction positive Vital reaction negative and no
and congestion congestion
 Differential Diagnosis of abrasions
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1. Post mortem erosions produced by antes’bite (brown erosions

with irregular margins of the superficial layer of the skin at the
mucocutaneous junction like around eyelid, nose, ear, mouth,
axilla, lips, groin…)
2. Excoriation of skin by excreta ( at the napkin areas)

3. Pressure sores (points of pressure)

4. Drying up of the skin

 II. Medicolegal importance of
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bruises/contusions/hematoma
 Bruise is of lesser importance than an abrasion because:
 Size of a bruise may not correspond to the size of the weapon used
 Bruise may appear late after injury
 Bruise may appear in far away regions of the body from the actual site of
injury.
 However bruise can help in assessing certain facts such as:
 Causative weapon--shape
 Time since injury--color change
 Degree of violence--size
 Characteristics and manner of injury
 Determination of the age of the bruise
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 Differential diagnosis of bruises
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 Artificial/ fabricated bruises

 Postmortem bruising: Bruises cannot be produced after 2

minutes of death. However, small bruises can be developed by
great violence even up to 3 hours of death

 Postmortem hypostasis/lividity
 Differences between artificial and true bruise
Characteristic True bruise Artificial bruise
11s

Cause Blunt force Irritant chemicals

Site Anywhere on the body Exposed and accessible parts
Color Typical color changes Dark brown and no color changes
Shape Round or oval and may mimic Irregular in shape
the weapon of offense
Margins Not well defined and are Well defined, regular and covered with vesicles
diffuse
Redness & Seen at the site Seen in the surrounding skin due to the irritants
inflammation
Contents Extravasated blood Acid serum
Itching Absent Present
Vesicles Absent Found in the area and also at the fingertips due to
itching
 Differences between antemortem
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and postmortem bruises
Characteristics Antemortem Bruise Postmortem
Bruise
Tissues underneath Blood infiltrates the tissues Tissue stain do not
and stains them. That tissue resist washing
stain resists washing
Color change Seen Not seen
Swelling positive Negative
Damage to epithelium positive negative
Extravasation and positive negative
inflammation
of blood in tissue
 Differences between bruise and postmortem
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hypostasis
Characteristic Bruise Hypostasis
s
Cause Due to extravasation of Due to distention of vessels
blood from ruptured blood with blood in it after death
vessel
Site Occurs at the site of impact Occur on the dependent parts
and can be anywhere over of the body
the body
Appearance The area of impact shows No associated swelling, no
swelling, abrasion may be abrasion associated
present
 Differences between bruise and postmortem
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hypostasis…
Bruises Hypostasis
color Color changes see depending Uniformly bluish purple
upon the age of injury
Incision of Blood is found in extravasated Blood is found intact within the
lesion into the subcutaneous tissue and blood vessels or in the
can not be washed away surrounding are and can easily be
washed away
Effect of No blanching effect Deep pressure over the area will
pressure cause blanching of the hypostasis
 III. Medicolegal importance of lacerations
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1. The type of laceration -> cause and shape of weapon used

2. Lacerations can provide clues regarding the motive of injury:
 Accidental—commonly seen anywhere on exposed parts of the body
 Homicidal—especially noticed on non-accessible parts of the body especially in
assault cases
 Suicidal—are very rarely seen as they are painful to produce.
3. Foreign matter in the wound could give clues about the weapon used, etc.
e.g. paint material of causative vehicle may be transferred onto the
lacerated wound.
4. The skin flap, which overhangs the cut margin (avulsion cases)can indicate
the direction of force applied.
 IV. Medicolegal importance incised wound
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 The wound may have to be distinguished from an incised like

laceration (tissue tags/bridges are not seen in incised wound)

 The wound could give clues regarding the motive by noting the:
 Hesitation cuts/tentative cuts
 Defense cuts

 The wound could also give clues on weapon causing the wound,
time since injury, site of impact and direction of force
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Hesitation cuts/tentative cuts

 are parallel superficial cuts suggestive of suicidal motive,

 seen in the vital parts of the body such as neck, chest on left
side, wrists, etc.
 are inflicted by the victim, prior to the final fatal deep cut or
stab, e.g. suicidal cutthroat wound.

Usually hesitation cuts are not seen in homicidal cut throat wound
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Defense cuts: Active and Passive

 are incised wounds suggestive of homicidal motive or assault

with sharp weapon,
 seen on a victim’s forearms and hands, while making either an
attempt to grab the weapon by its blade  active defense
wounds or just taking the weapon on his parts in order to protect
himself from the attack  passive defense wound
 V. Medicolegal importance of stab wounds
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(Punctured Wound)
1. The wound could give clues about:
 Motive, i.e. if seen on accessible parts of the body along with a few hesitation
cuts around wound of entry, it is suggestive of suicidal stabbing.
 Weapon causing the wound
 Direction and force of penetration
 Time since injury.
2. Concealed punctured wounds—punctured wounds made by pins and
needles, usually difficult to locate by naked eye examination and missed
by the inexperienced autopsy surgeon. They are commonly inflicted on
fontanels, inner canthus of the eyes, up in the nostrils, down into the
throat, into the nape of the neck, axilla, vagina, rectum, etc
 VI. Medicolegal importance of chop wounds (chop
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lacerations)
 Chop wounds are usually seen on exposed parts such as head,
neck, face, shoulders and extremities.
 Usually they are accompanied by severe injury to underlying

bones and organs

 Majority are homicidal

 A few are accidental due to machinery such as—propeller injuries

 Very rarely they could be suicidal

 Wound examination could reveal clues regarding causative

weapon.
 References
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 Nageshkumar G Rao. Textbook of Forensic Medicine and Toxicology. 2th

ed. 2010. Jaypee Brothers Medical Publishers (P) Ltd

 Saukko P. , Knight B. KNIGHT’S Forensic Pathology. 3rd ed. 2004 Edward

Arnold (Publishers) Ltd

 Jason P-J., Jones R., Karch S. B., Manlove J. Simpson’s Forensic Medicine.
13th Ed . 2011 Hodder & Stoughton Ltd
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Thank you