7 - Wounds Part4 by xiaohuicaicai

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									By: Ammar Mansour
Incised wounds
 Clean seperation or division of the full thickness of
 skin under the pressure of a sharp-edged instrument
 (knives or broken glass)
 Incised wounds
Types:
   Slash wounds:
       Length > depth. Generally NOT as serious as
        stab wounds unless it involves major blood
        vessel.


   Stab wounds:
       Depth > length. More SERIOUS as they tend to
        come in contact with vital organs in chest and
        abdomen.
Comparison:
       Lacerations               Incised wounds
Trace evidence (rust or dirt) Clean

Shape is NOT according to    Shape is according to
cause                        cause
Ragged edge                  Everted edge (turning outwards)

RARELY self-inflicted        May be self-inflicted
Self-inflicted injuries
Self-inflicted injuries




 Cuts are usually superficial, multiple and parallel.
 In right handed people most of injuries are on the
 left side.
Features of SUICIDAL knife wounds

 Certain sites : throats, wrists and the front of the
  chest are more common.
 They are often multiple, but there are deep cuts.
1)Throat




In slashing throat suicidal injury ,throwing back the
 head, moves the carotid bundle under the protection of
 the sternomastoid muscles. So if the cut is confines to
 the front of the neck, only the larynx or trachea may be
 damaged
1)Throat
  Stab wounds of the neck are UNCOMMON in suicide.
 2)Wrist




 Deliberate cutting of the wrists is RARELY effective as
 a sole method of suicide but it is a COMMON injury
3)Chest




Suicidal injury of the chest are almost always   stab
 wounds
Defense Wounds
Defense Wounds

 Definition:
    A wound sustained when a victim places a hand, arm or
     other body part to prevent or minimize a blow or slashing
     by a sharp weapon.




 Usual sites:
The outer-side of the forearm
Back of the hand
Fingers
 Bruises may be seen at the outer-side of the thigh as
 the victim crosses his legs to protect the genitalia.
Duty of the Doctor
Make a detailed examination and provide a medical
 report that can be used in subsequent criminal or civil
 proceeding.
The purpose of examination is to determine:
   The time of the wound in relation to death.
   How it was caused.
   What is the cause.
   What amount of force was used to produce it.
   The degree of injury that was caused by the wound
    (whether the wound influenced death or disability).
                 Changing in bruising:
                 Dark red. less than 24 hours
                 •Dusky purple.
                 •Brown. From 1-3 days
                 •Green. 3 to 5 days
                 •Yellow.5 to 7 days
                 •Straw.
How to describe a wound
The nature of the wound (bruise, laceration or abrasion).
The wound dimensions (length, width and depth).
The position of the wound in relation to fixed
 anatomical landmarks eg: distance from the mid line,
 distance below the clavicle…etc.
The number of wounds.
The margins of the wounds (Ragged or Everted)
Factors affecting wound
HEALING

Blood supply.
Infections.
Age
Site of wound.
Nutritional status.
Inter current diseases.
Drugs: corticosteroids, immunosuppressive,
 radiotherapy, chemotherapy.
Complications of wounds
 Infection and sepsis.
 Bleeding
 Hypovolemic shock.
 Injury to internal organs.
 Formation of scar.
Causes of DEATH due to
wound

Injury to a vital organ eg: brain.
Sever hemorrhage.
Shock
Pulmonary embolism.
Septicemia
Renal failure due to rhabdomyolysis (crush
 syndrome).
Thank you

								
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