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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 endingsdilatation 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/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 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 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 edgepressure 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