LECURER , FORENSIC MEDICINE,MCST Wounds Medicolegal view Dr. Aly Samy Somaa MB.ChB,Msc,ABFMD,MD LECURER , FORENSIC MEDICINE,MCST Dr. Aly Samy 2013 Dr. Aly Samy ,PSMCHS

Objectives: To know the following definition and classification of wounds the type of trauma and wounds of medico-legal importance factors affecting the wound estimate the date of wound occurrence different types of wounds complications of wounds Dr. Aly Samy 2013

Definition of Wound Disruption of the continuity of tissues produced by external mechanical force Dr. Aly Samy 2013

Origin of word: Injury From Latin: “injuria” (in- not, jus- the law) The term is often used synonymously with wound but can have a wider use, including damage to tissues by Heat Cold Chemicals Electricity Radiation Mechanical force Dr. Aly Samy 2013

Classification of wounds Legal classification: A- simple wound جـرح بسيط: which heals rapidly in less than 20 days leaving no deformity and no permanent infirmity. B- Dangerous wound جـرح خطير Dr. Aly Samy 2013

Classification of wounds- cont which heals in more than 20 days and/or leaving a permanent infirmity. C- Fatal or mortal wound جـرح مميت : which cause death immediately or later due to complications Dr. Aly Samy 2014

Medicolegal classification Abrasions Contusions Cut wounds Dr. Aly Samy 2013

Medicolegal classification-cont Contused wounds Stab wounds Firearm wounds Dr. Aly Samy 2013

1-Abrasions Destruction of the superficial layers of the skin following contact with rough object. Bleeding is minimum, it heals rapidly in few days. Abrasions are usually localized at the site of trauma Dr. Aly Samy 2013

1-Abrasions Blunt force applied perpendicular to the body surface Scrape. dragging: Dragging of the body as in street accidents, broad and multiple and may take the shape of the causative instrument. Sliding: sliding semi sharp object as finger nails leading to parallel lines Impact abrasion Blunt force applied perpendicular to the body surface Overlying bony prominence pattern/imprint abrasion finger nail ligature or rope abrasion Dr. Aly Samy 2013

Medicolegal importance of abrasion It may be the only evidence of a crime 1. Type of the crime from its site. e.g. smothering. Abrasions around mouth throttling .Abrasions around neck strangulation Hanging or rape. Dr. Aly Samy 2013

Medicolegal importance of abrasion- cont 2. The instrument used: Finger nail Bite Rope dragging 3,Direction of the injury and position of the assailant 4. Identify the assailant 5.Differentiate incised and contused wounds. Dr. Aly Samy 2013

The age of abrasion The age of abrasion gives an idea about the date of the crime: 1st day: It is reddish, tender, oozing serosanguinous . 2nd day: soft yellow scab 3rd day, it is covered with brown red soft scab. Gradually the scab dries up and 4TH DAY become dark brown. 7-10 days : Fallen of the dry scab occurred from leaving a red colored area. Disappearance of the abrasion occurred in three weeks Dr. Aly Samy 2013

DIFRENCES BETWEEN AM &PM ABRASIONS AM ABRASIONS PM ABRASIONS A-Reddish, swollen. ABSENT B-May be accompanied by bruises C. On microscopic exam.  Vital tissue reaction D. Some remnants of the damaged epithelium. E. Occur anywhere Dr. Aly Samy 2013

2-Contusions or burises 1. Definition:- Extravasations of blood in the tissues following rupture of blood vessels as a result of application of blunt force. It varies in size from a small pin head ecchymosis to a large collection of blood, known as hematoma Dr. Aly Samy 2013

first bright red (oxy HB)  violet, then  bluish (reduced HB) The color of a bruise first bright red (oxy HB)  violet, then  bluish (reduced HB) green (biliverdin)  yellow (bilirubin) It gradually disappears in 15 days (range from 2-4 weeks). The color changes occur from the periphery inwards Dr. Aly Samy 2013

Danger of the bruises 1. Neurogenic shock. 2. Injury to internal organs and hematoma. 3. Liability to sepsis and death from septicemia.

Medicolegal importance of the bruises 1. evidence of crime or violence. 2. evidence of signs of resistance. 3. The date of the crime can be estimated from its age. 4. instrument used (from its shape). 5. Differentiate between incised and contused wound. 6. May be the cause of death. 7. It should be differentiated from hypostasis 8. Site : usually at the same site or may be shift as black eyes Dr. Aly Samy 2013

DIFRENCES BETWEEN AM &PM BRUISES AM BRUISES PM BRUISES SWELLING NO CHANGE OF COLOR CELLULAR REACTION BLOOD CLOTING

DIFFERENCE BETWEEN HYPOSTASIS AND BRUISES BRRUSIES HYPOSTASIS SWELLING AT AGES NO ANY SITE OF THE BODY DEPENDENT AREA NO BLANCHED BY PRESSURE YES CUTTING OVER SHOWS BLOOD CLOT COULDN’T BE WASHED OUT Accompanied by abrasions

Hypostasis: 1. A postmortem change. 2. Site: dependent parts. 3. Intact Skin. 4. No swelling, no color changes and no marked edges. 5. By pressure the color disappear. 6.The blood is intravascular, and fluidly. 7. No cellular infiltration

3. contused wound 3- Contused wound Definition: An open injury produced by the impact of blunt force against the body. It is caused by a stick, stone, or fall from a height. The edges are usually abraded with contusions around, and the angles may be multiple and irregular. Dr. Aly Samy 2013

4-Lacerated wound Definition It is a contused wound where the edges are severely damaged and highly irregular, with multiple angles. Dr. Aly Samy 2013

Medicolegal importance of contused wound 1.It indicates the type of injury and causal instrument. 2.Could simulate incised wound in the skin stretched over bone e.g. scalp. 3.If in the head it may accompanied by fracture.

Danger of Contused wound 1.Liability to sepsis. 2.Neurogenic shock. 3.Crush syndrome. Myoglobinuria  Renal failure. 4.Fat embolism (fracture of long bones). 5.On healing a scar is produced  may leave permanent infirmity.

5-Incised wound (cut wound) Definition: It is produced by drawing the sharp edge of a sharp instrument along the surface of the skin with sufficient pressure e.g. of sharp instrument, knife, razor, and broken glass. Manner of incised wound suicidal homicidal accidental defense Hesitation Therapeutic

6-Incised wound (cut wound)

Danger of incised wound 1. Severe bleeding. 2. Cutting of important nerves and tendons. 3. Air embolism. 4. Infection

Medicolegal importance of incised wound 1. It indicates the type of instrument used. 2. Its site indicates the type of crime whether homicidal or suicidal. 3. Could simulate contused wound.

Antemortem or post mortem cut wound Edge gap widely No gapping hg No hg Blood clot at the base No blood clot Swollen edges No swelling Evidence of sepsis of healing Cellular reaction no

6- Stab wound Definition:- A wound caused by thrusting or forcing sharp pointed instrument into the body, having a sharp edged blade e.g. knife, scissors. Dr. Aly Samy 2013

Wounds similar to stab Punctured Wound: Caused by thrusting an instrument with a blunt edge and pointed end e.g. nail. Dr. Aly Samy 2013

Wounds similar to stab Penetrating Wound: These are stab or punctured wounds reaching a body cavity eg: chest (pleura, pericardium), abdomen (peritoneum), joint cavity. Transfixing Wound = Perforating Wound: These are stab or punctured wounds transfixing a limb or even the whole body. Dr. Aly Samy 2013

Characters of stab wound 1. More deep than long. 2. The edges : are cleanly cut without surrounding abrasions or contusions. 3. The shape: - Bibladed knife(double dladed)  Two pointed sharp angle. - Monobladed knife(single bladed)  One end is sharp pointed, the other is transverse Dr. Aly Samy 2013

Danger of stab wound 1. Neurogenic shock. 2. Injury to vital organs. 3. Internal hemorrhage. 4. Sepsis. Dr. Aly Samy 2013

DEFENSE WOUNDS = SELF PROTECTION WOUNDS These results from the victim's spontaneous reaction of self protection when he is attacked. He may either grasp the weapon to prevent it injuring a vital part, or may raise his arm or hand to ward off an attack.

DEFENSE WOUNDS = SELF PROTECTION WOUNDS

Fabricated wound They are usually done by the person himself (self inflicted wounds) to give suspicious of self defense or by the aid of another person in agreement with him. They are usually superficial, consists of a series of parallel or crossing incisions.

Fabricated wound Commonly seen over accessible parts e.g. top of the head, forehead, neck, front of chest or abdomen. Usually there is no corresponding cuts on the clothes.

Causes of death from wound I. TRAUMATIC SHOCK A. Primary or neurogenic shock: i. Death from reflex vagal inhibition of the heart i.e. parasympathetic stimulation  slowing of the heart  instantaneous death. ii. Death from sympathetic stimulation of the cardiovascular system . B-Secondary or hemorrhagic shock

Causes of death from wound cont II. HEMORRHAGE: Types of hemorrhage: 1. Primary hemorrhage follow immediately after injury. 2. Reactionary hemorrhage is usually delayed for several hours up to 24 hours after injury. 3. Secondary hemorrhage is due to infection of a wound, it occurs between 10-16 days after injury

Causes of death from wound III. INFECTION OF THE WOUND. IV. EMBOLISM: A. Air embolism The minimum amount of air to cause air embolism is 60 ml. B. Pulmonary embolism due to deep vein thrombosis. C. Fat embolism.

CASES- I. A PHOTO showing: ORGAN:----------- Causative instruments  ------------- against a rough surface AS-------------------- Victim died soon after the injury (absence of any evidence of healing or sepsis)   Dr. Aly Samy 2013

CASES- II. A PHOTO showing: -------------------- Causative instruments their colour points to there A, M. nature absence of any evidence of healing or sepsis indicates that death happened soon after the injury.  Cause of death: ------------------- Neurogenic shock. Dr. Aly Samy 2013

CASES- III. A PHOTO showing: the anterior ----------chest wall showing lesion: ----------------------------- SIZE .5X1.5 cm Site: about -------------- Elliptical in shape i.e. caused by single ------------------. Dr. Aly Samy 2013

CASES- III. A.M. wound (presence of hg.) Death occurred soon after the injury (absence of any evidence of healing or sepsis of surgical interference. Causes of Death: ---------------------- Haemorrhage Dr. Aly Samy 2013

IV A PHOTO showing: -------------------------- ---------------------------wound ------------------------instrument. DESCRIPTION   -------------------------- --------------------------- Possible cause (s) of death: Brain laceration Interacranial Haemorrhage.   Dr. Aly Samy 2013

Dr. Aly Samy 2013