WOUNDS AND INJURIES

Wounds and injuries

DEFINITION

Disruption of the normal structure of tissues

caused by the application of force.
 Wounds and injuries

Legal definition of a wound

a wound is where the whole skin is broken,

the continuity of the skin broken.
An abrasion of the surface is not sufficient.
Splits of the inside of the mouth are included
but not fractures or internal injuries
if the overlying skin is intact.
 Wounds and injuries

A wound implies a deliberate action

while an injury can be caused accidentally.

 Interpretation of injuries

This is the most important part of the forensic examination

The nature of the agent(s) causing the injuries

may be identified in general terms
e.g. due to a blunt object or a sharp object.
The pattern of the injuries on the body
may help in deciding the circumstances
in which the injuries occurred,
accident, suicide or homicide.
 Describing injuries

1.The nature of the wound, ie whether it is a

bruise, abrasion or laceration etc
2.The wound dimensions, eg length, width,
depth etc.
3.It is helpful to take a photograph of the
wound with an indication of dimension (eg a
tape measure placed next to the wound),
4.Measurements to be taken of the wound as it
appears first, and then with wound edges
drawn together
 Describing injuries

5.The position of the wound in relation to fixed

anatomical landmarks, eg distance from the
midline, below the clavicle etc
6.The height of the wound from the heel (ie
ground level) - this is particularly important in
cases where pedestrians have been struck by
motor vehicles
Blunt force injuries
• Abrasions
• Bruises
• Lacerations
Injuries due to sharp or
long instruments
• Incised wounds
• Stab wounds
 Bruise
• Crushing of tissues
• epidermis uninjured
• connective tissue crushed
• small vessels ruptured and bleed into tissues
• common in young and old, haematological
problems
• falls, assaults
 Bruises/ Contusions
•Bruises are caused by blunt trauma / injury to tissues,
resulting in damage to blood vessels beneath the surface.

•Blood leaks out ('extravasation') into surrounding tissues

from damaged capillaries, venules and arterioles.

•Bruises may be surface bruises, or deeper within tissues or

organs.
 Bruises/ Contusions
•Unlike abrasions, the characteristics of the object causing a
bruise cannot easily be determined, because blood tends to
spread out in a diffuse manner from the site of injury,
particularly along fascial planes.

•'shifting' of bruises after time. For example, from faace or

scalp to neck

•Bruises may also 'appear' after some days due again to the
same phenomenon of blood tracking along tissue planes, and
pathologists often re-examine a body again to look for such
bruising.
 Bruises/ Contusions

Intra-dermal bruises, however, provide an exception to

this general rule, as they are superficial - lying just under
the epidermis.
In this case, there may be good correlation between the
bruise seen and the characteristics of the causative object
e.g. tramline bruises.
 Bruises/ Contusions

Ecchymoses/ purpura - smaller than a few

millimeters

petechiae - pinpoint bruises(usually due to venous

engorgement, e.g. in asphyxia, or in defects in blood
coagulation such as Disseminated Intravascular
Coagulation (DIC)).

Senile purpura – flat purple bruises in elderly

 Bruises/ Contusions
A blow from an object may give rise to a combination of
injuries, such as a bruise with an abrasion etc, and different
parts of the body are more susceptible to bruising than
others.

For example, the skin over the eyelids bruises easily, whilst
the tougher palmar surface or plantar surface rarely bruises,
unless severe direct trauma e.g. fall from a height or torture.
 Bruises/ Contusions
The positioning of bruising is significant e.g. multiple rows of
spherical/ disc shaped bruises may be seen when an attempt is
made to strangle someone with bare hands (manual
strangulation).

The bruises are caused by the attacker's fingertips pressing

into the skin.
 Bruises/ Contusions
'Tramline' bruises

Consist of two parallel linear bruises separated by a paler,

undamaged section of skin.
This type of injury occurs when the skin is struck with a rod
shaped object, which squeezes blood from the vessels at the
point of inpact, thus emptying them and preventing them from
leaking blood. The edges of the wound are stretched, and
blood vessels are torn, causing blood to leak into the
surrounding tissues.
A similar phenomenon is seen when the injury is caused by a
hard spherical object, such as a squash ball !
 Abrasions
• Surface injury
• graze or scratch
• rough surface striking the body tangentially
• crushed epidermis, pressure or imprint
abrasions
• examples: ligature mark, fingernail
scratches, tyre marks, ground or gravel
injuries e.g. grazed knees
 Abrasions

An abrasion is a superficial injury, commonly known as a

'graze' or 'scratch'.

This type of wound damages only the epidermis

(uppermost skin layer), and should not therefore bleed.

However, abrasions do usually extend into the dermis

causing slight bleeding.
 Abrasions
Abrasions are commonly caused by a 'glancing' impact across
the surface of the skin,

If the force is directed vertically down onto the skin surface it

may be termed a 'crush' injury.

These wounds are seen where an object has struck the skin (eg
a kick), or where the injured person has fallen onto a rough
surface, such as road.
 Abrasions
Abrasions may be 'linear', a 'scratch'

If broader surface is affected, it is called a 'graze' or 'brush

abrasion' (eg where a motorcyclist is thrown from their
vehicle, and comes into contact with the road surface in a
skidding fashion). Such an abrasion often covers a relatively
large area of skin, and is often called a 'friction burn’.
 Abrasions
If the surface of an abrasion is examined closely, for example
with a hand-held magnifying glass, the direction of force can
often be determined, from the torn epidermis.

Strands are drawn towards the end of the injury, and are 'heaped
up'.
The edges of the wound may also be ragged and directed
towards the end of the wound.
 Abrasions
Of particular importance in the forensic setting is the fact that
abrasions can retain much of the surface characteristics of the
object that caused the wound.

For example, there may be a patterned abrasion caused by an

element of a vehicle involved in a 'hit-and-run' (such as that
made by a radiator grill or bumper), and if the abrasion has
been fully documented and photographed (with a scale) and
the suspected vehicle is subsequently recovered, the two may
be matched up.
 Lacerations
• Breach in epidermis and dermis
• crush injury
• common where skin stretched over bone,
scalp, face and shins
• margins bruised and abraded
• tissues not cleanly divided, tissue ‘bridges’
across base of wound
• bleed profusely
• falls, kicks and blows from object
 Lacerations

These wounds are commonly known as 'gashes, tears

or cuts' of the skin.

The skin surface is split or torn following blunt

trauma, and the force causes the full thickness of the
skin to be damaged.

Lacerations therefore bleed profusely.

 Lacerations

Areas of the body that are commonly the site of lacerations

are those with underlying bony support, such as above the
eyebrows, on the scalp and face, or over the knees etc,
whilst they are less common on areas of the body that are
softer such as the buttocks.

Contact with motor vehicles may also cause splitting of the

skin due to grinding type movements over the surface, the
most severe being a ‘degloving’ injury.
 Lacerations

Lacerations have ragged wound edges, as they have

been torn apart and not neatly incised as in a surgical
wound.
scalp lacerations sometimes resemble incised wounds
when they have been caused by a regular shaped
object.
If the wound is examined closely the ragged edges
can be visualised, along with crushing and bruising of
the margins, hairs driven into the tissues and tissue
strands crossing the depth of the wound (nerves, fibrous
brands, vessels)
 Stab wounds
• Caused by long object
• penetrate body
• small surface wound, depth varies
• shape depends on object penetrating
 Stab wounds
.
These are wounds where the depth of injury is greater than the
length.

They penetrate more deeply than slash wounds and tend to come
into contact with vital organs in the chest and abdomen

Stab wounds are caused most obviously by knives,

but are also caused by bayonets and swords,
as well as scissors and even blunter instruments such as
screwdrivers.
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Stab Wounds
 Incised wound
• Due to sharp instruments
• length greater than depth
• wound margins uninjured
• deep tissues cleanly cut
• e.g. surgeon’s incised wound
 Incised wounds

Slash Wounds

These are wounds where the length is greater than the depth,
eg a slice wound across the skin.

If the wound involves major blood vessels, it can be life

threatening, but in general, they are not as serious as stab
wounds.
 Other injuries

• Weals
• Glass injuries
• Axe injuries
• Thermal injuries
• Firearm injuries
• Defence injuries
• Self-inflicted injuries
 Miscellaneous
• Weals - triple response
• defence injuries - assaults; arms, hands, legs
• self inflicted - haphazard on arms or body in
mental disorders
• tentative injuries - suicide attempts; short,
shallow wounds on wrists or neck
 Age of injuries

• Colour changes in bruises - purple to yellow

• scab formation in abrasions
• scabbing and scarring of laceration
• histological examination of tissues
Bruises change colour over time, because of the degradation of haemoglobin in the blood. However,
the timescale of this degradation is not fixed, and it is therefore possible only to give a rough
estimation of the age of the bruise. Colour changes are from dark blue or purple to blue, brown,
green and yellow
 Age of bruises
Bruises change colour due to degradation of haemoglobin
Timescale of this degradation is not fixed
Possible only to give a rough estimation of the age of the bruise.
Colour changes are from dark blue or purple to blue, brown, green
and yellow
In general, small bruises on an otherwise fit and healthy person,
could pass through the spectrum of colour changes between 72
hours and 1 week.
The more extensive, or deep seated the bruise, the longer it will
take to dissapear.
If a bruise is brown/ green or yellow it is likely that the injury is at
least 18 hours old
Markedly different coloured bruises suggest that they have been
caused at different times, and may indicate signs of chronic abuse,
such as of an infant etc.
 Death from injuries
• Haemorrhage
• damage to vital structure
• shock
• infection
• pulmonary thromboembolism
• acute tubular necrosis
• fat embolism
The rounded clear holes seen in the small pulmonary arterial branch
in this section of lung are characteristic for fat embolism. Fat embolism
syndrome more commonly due to trauma with long bone fractures. It
can also be seen with extensive soft tissue trauma, burn injuries, severe
fatty liver, and very rarely with orthopedic procedures.
An Oil Red O stain demostrates the fat globules within the pulmonary
arterioles. The globules stain reddish-orange. The cumulative effect of
these gobules throughout the lungs is similar to a large
pulmonary embolus, but the onset of dyspnoea is usually 2 to 3 days
following the initiating event, such as blunt trauma with bone fractures.
The capillary loops of this glomerulus contain fat globules in a patient
with fat embolism syndrome.
With cerebral fat embolism syndrome, there is loss of consciousness.
Note the multitude of petechial hemorrhages here, most in white matter.
Cerebral oedema and herniation may follow.
Few persons with a history of trauma will develop fat embolism
Seen here with Oil red O stain in a peripheral cerebral artery branch
are globules of lipid. This is fat embolism syndrome.
Treatment is supportive.