Assoc. Prof. Beatrice Ioan MD, PhD, MA INJURIES Assoc. Prof. Beatrice Ioan MD, PhD, MA

Definition & classification Definition → damages to the tissues of the body caused by mechanical forces I. Intact skin - Traumatic eritema Bruise (contusion) Hematoma II. Injured skin Abrasion (scratch, graze) Wounds

Traumatic eritema produced by a light slap or a continuous pressure against the tissues transient irritation of the nervous endings- dilatation of the vessels pain, redness of the skin/ red points on the skin, tumefaction all signs and simptoms dissapear in a few hours

Bruise/contusion Blunt injury to the tissue- strike or compression Blunt objects: rock, stick, club, hammer, fist, leg ↓ Damage of the small and middle blood vessels beneath the skin- the blood leaks into the surrounding tissues Most frequent under the skin Possible deep bruising- any organ, tissue

Bruise changes with time and position Bruise/contusion Usually it does not reproduce the pattern of the causative object- the blood leaks in a diffuse manner Bruise changes with time and position The bruise may become visible at a later moment from the trauma - repeated examinations The bruise may appear at a different site than the injury site

Bruise/contusion Timing → colour changes Chemical changes of hemoglobin the first hours- red (HbO2) few hours- bluish (reduced Hb) 3-5 days- green-yellow (biliverdin) 7-8 days- yellow- brownish (hemosiderin) 7-20 days- normal skin colour (depend on the size and depth of the bruise).

Bruise/contusion The speed of the changes is variable- 7-10 days Recognition of bruises of different colours in the same person- inflicted at different times- repeated aggressions- child/adult abuse Differentiated from postmortem lividities

Bruise/contusion - Size space outside the vessels for free blood to accumulate; gravity of the bleeding, depending on: * the intensity of the traumatism; * the size and the density of the vascular network in the damaged region; presence of the bone directly under the skin; depth of blood accumulation; fragility of blood vessels; coagulability of the blood

Particular types of causation- mark bruises Bruise/contusion Particular types of causation- mark bruises “Tram-line”/”railway-line Bilateral ovalar bruises on the throat- manual strangulation Envelope imprint

“Tram-line”/”railway-line” - two parallel lines of bruising with a pale undamaged area between- rod-like weapon, either cylindrical or square-sectioned

Localization: tissues, organs, natural cavities Hematoma Definition- an important collection of blood- the rupture of a big vessel- blunt injury Localization: tissues, organs, natural cavities Superficial hematoma- the covering skin is bruised; May compress the muscles, nerves, vessels- surgical treatment to evacuate the blood; Hematomas in the natural cavities or inside the organs have, frequently, a severe evolution- even death

Abrasion The most superficial type of injury which destroys the integrity of the skin Mechanism: - Friction of a sharp or irregular object against the surface of the skin, determining the abrasion of the superficial layers. Less often- vertical impact- crushed injury Two possibilities: An object strikes the skin (a bite from a tooth) The body hits a stationary object (fall)

Abrasion Usualy confined to epidermis- no bleeding Some abrasions enter the dermis- slight bleeding (dermal papillae) Shape: Linear Broader- brush abrasion E.g., dragging across a rough road in traffic accidents- multiple parallel linear abrasions When the skin is protected by clothing- “friction burn”- reddened, excoriated area

Abrasion Evolution the first 12- 24 hours- crust (yellow or redish-brownish); 3-4 days- the crust begins to detach; 7-8 days- a white track on the skin - dissapears without any traces

Fingernail abrasions - strangulation by hand- curved /on the neck; - linear abrasions- the finger are dragged down the skin (sexual attacks, child abuse)

Marker- abrasion - usually when the impact is vertical to the surface of the skin (crushing abrasion);

Draging - linear, thin, parallel abrasions - direction of the force causing the abrasion- close examination- the torn epidermis will be pulled towards the distal (final) end of the abrasion

Laceration Blunt injury- the weapon crushes the tissues ↓ Penetrates the full thickness of the skin

Laceration- characteristics irregular edges; blood infiltration in the edges; bruises and abrasions in the surrounding tissues; persistance of tissue strands across the interior of the wound; the hair is not destroyed / may be crushed; content- crushed tissues, clots of blood, small pieces from the clothes, dirt; main complication- infection

Laceration- particular types Crack wound the skin is compressed between the bone and the blunt object- e.g. scalp; the margins are regular, sharp; must be differentiated from the cut wounds - the crack wound presents tissue strands across the margins - injuries in the surrounding tissues

Bite wound - preserve the shape of the teeth - samples of saliva- identification of the aggressor

Sting- pricking wound Mechanism Lateral compression of the tissues by a thin object with acute point - needle, screw driver (pricking object) Characteristics Entry wound on the skin/mucosal surface a red point if the weapon’s diameter is small (sharp needle) or a small wound with sharp edges if the weapon’s diameter is bigger

Sting- pricking wound Channel in the depth of the tissues Exit wound rare the damaged part of the body is small/thin the weapon is long enough

Sting- pricking wound Complications severe, even lethal bleeding when blood accumulates inside a natural cavity (e.g. pericardium) death- when the heart or fontanel (infanticide) are damaged

Cuts Sharply cut injuries Produced by objects with at least one cutting edge- pressure and movement of a sharp edged object against the tissues Classification cuts (slashes)- larger than deeper, usually linear; partial detachment of the tissues- the cut is oblique; complete section of a part of tissue, an organ (nose) or a part of a limb

Cuts - characteristics regular edges; surrounding tissues- intact; no tissue strands in the interior of the wound; the hair is divided; the cut is deeper at the entry, becomes progressively shallower as the wound approaches the distal end → linear abrasion - mouse tail content- blood (liquid or clots); main complication- bleeding

Cuts Defence wounds passive defence- cuts on the dorsal part of the hands and forearms; active defence- cuts on the palms (the victim tryes to catch the knife).

Stab wound Mechanism: pricking and cutting the tissues, by an object with an acute point and sharp edge/edges Characteristics Entry wound on the skin; characteristics of a cut wound; according to its aspect, is possible to determine if the knife has one or more cutting edges edges * buttonhole- two cutting edges * triangle- one cutting edge

Stab wound Channel In the depth of the tissues its direction shows the weapon’s direction inside the tissues; Exit wound characteristics of a cut wound According to the aspect of the entry wound and channel is possible to estimate the dimensions of the knife in the cavities with a bony wall

Split wound Mechanism: heavy objects with a sharp edge- axe, hoe, heavy sword Appearance - combination between cut wound on the surface of the skin and laceration in depth Frequent Bone fractures Damages in the vital organs danger for life

Description Location Dimensions Shape Direction Aspect - bruise – colour - abrasion – crust - wound - margins - surrounding tissues - ends - content - stage of healing

Injuries - forensic relevance The damaging weapon → marker injury Producing mechanism - injuries located on the prominent parts of the body → fall - bruises and abrasions on the neck – strangulation by hand/ligature Timing of trauma - bruise - colour - abrasions - aspect of the crust - wounds – stage of the healing – aspect of the scar