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Types of Wounds

The document describes different types of wounds including abrasions, contusions, lacerations, incised wounds, and gunshot wounds. It provides details on identifying features of each type as well as factors that affect bruising and considerations for determining weapon type from a gunshot wound. Key factors discussed include presence of epidermal tags, crushing versus tangential impact, vessel fragility, wound shape, stippling, soot deposition, and clothing effects.

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Mwanja Moses
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267 views40 pages

Types of Wounds

The document describes different types of wounds including abrasions, contusions, lacerations, incised wounds, and gunshot wounds. It provides details on identifying features of each type as well as factors that affect bruising and considerations for determining weapon type from a gunshot wound. Key factors discussed include presence of epidermal tags, crushing versus tangential impact, vessel fragility, wound shape, stippling, soot deposition, and clothing effects.

Uploaded by

Mwanja Moses
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Types of wounds

DR FRANK KAKUBA
Anatomical & clinical pathologist
ABRASIONS
• An abrasion is the most superficial of injuries and, in the most
restrictive of definitions, is one that does not penetrate the full
thickness of the epidermis.

• A true abrasion does not bleed because it only involves the epidermis,
and blood vessels are found in the dermis. But sometimes bleeding
occurs if injury involved the upper dermis not only the epidermis.
• Abrasions are known in lay terms as ‘scratches’ or ‘grazes’, though the
former usually indicates a linear mark and the latter a ‘brush’ abrasion
caused by wider tangential impact.
• There are many causes of abrasions, which are common everyday
lesions, especially in children whose legs are rarely free from some
scratches and bruises.
• Any contact that rubs across the epidermis and removes the
keratinized layer and underlying cells will cause that area to become
discoloured and moistened by exuded tissue fluid.
• Post-mortem abrasions are common, because mortuary instruments
and the moving of bodies into refrigerators and coffins can often make
marks.
• These abrasions commonly appear yellow and translucent, and are
absolutely devoid of any colour change at the edge.
Tangential or brush abrasions
• Most abrasions are caused by a lateral rubbing action rather than
vertical pressure.

• Where this tangential component is marked, the direction of the force


can often be determined by tags of epidermis dragged to the terminal
end of the abrasion.
Crushing abrasions
• Where the impact is vertical to the skin surface, no scraping or
tangential marks occur.
• Instead the epidermis is crushed and an imprint of the impacting
object is stamped on the surface.
Patterned abrasions
• Commonly, abrasions take the shape of the impacting objects and can
help in identying the weapons/objects. For example, car tires, shoe
soles etc…

• Students shall find out the differences between ante-mortem and post-
mortem abrasions.
CONTUSIONS OR BRUISES
• Although often combined with abrasions or lacerations, a pure bruise
lies beneath an intact epidermis and consists of an extravascular
collection of blood that has leaked from blood vessels damaged by
mechanical impact.
• Bruises are caused by damage to veins, venules and small arteries.

• The word ‘bruise’ usually implies that the lesion is visible through the
skin or present in the subcutaneous tissues, whilst a ‘contusion’ can be
anywhere in the body, such as the spleen, mesentery or muscles.
Factors affecting the prominence
of a bruise
• As it is a leakage of blood from a vessel, there must be sufficient space
outside that vessel for free blood to accumulate.
• This explains the ease with which bruising appears in lax tissues such
as the eye socket or scrotum and its rarity in the sole of the foot or
palm of the hand, where dense fibrous tissue and restrictive fascial
planes prevent accumulation of blood.
• The apparent prominence of a bruise beneath the skin varies with the
amount of blood in the extravasation.
• The size of the haemorrhage depends partly, but not entirely, on the
intensity of the injuring force.
• For a given impact, the volume of blood lost into the tissues can depend upon
the fragility of the blood vessels and the coagulability of the blood.
• In old persons, vessel fragility may be extreme and a large bruise may develop
from the slightest of knocks.
• Children tend to bruise more easily than adults, presumably because of the
softer tissues and the smaller volume of protecting tissue that overlies the
vessels.
• Any bleeding diathesis resulting from disease, a toxic condition, or certain
medication, will also retard the normal clotting process that heals the breach in
the bleeding vessels.
• Those with scurvy and chronic alcoholics bleed easily
LACERATIONS
• Its simply anon uniform/irregular skin/tissue tear by blunt
objects/surfaces.
• Lacerations differ from incised wounds in that the continuity of the tissues
is disrupted by tearing rather than clean slicing.

• Unless great force is used, most lacerations require a firm base to act as an
anvil for the skin and underlying tissue to be pinned against.

• It is unusual for a blunt impact to lacerate the abdomen or buttock, but the
scalp, shins, shoulder and face commonly suffer lacerations.
• The persistence of tissue strands across the interior of the wound,
including fascial bands, vessels and nerves also defines a laceration.
INCISED WOUNDS
• Injuries caused by sharp objects are classified as ‘incised’ wounds.

• The term ‘incised wound’ usually covers all types of injury from, for
example, a knife, sword, razor, glass or sharp axe.

• CUT wounds and STAB wounds can mean the same, the difference being the
shape of the wound.

• The essential feature of all incised wounds is the clean division of the skin
and underlying tissues so that the margins are almost free from any damage
• The stab wound can help identifying the type of weapon, for
knives you can tell if it is single or double edge cutting.
• The depth of a stab wound may be important in attempting to assess
the length of a missing weapon and the force impacted.
Gunshot and explosion
deaths
• All mechanical trauma, whether punching, stabbing or kicking, is
caused by the transfer of energy from an external moving object to the
tissues and nowhere is this more obvious than in shooting.

• For damage to occur, some or all of the kinetic energy of the missile
has to be absorbed by the target tissues, where it is dissipated as heat,
noise and mechanical disruption.
• When a missile passes completely through soft tissues, it may retain
much of its original kinetic energy and fail to transfer any appreciable
amount to the tissues, which may remain relatively intact apart from
the immediate bullet track.
• To ensure transfer of energy to the tissues, some missiles are
especially designed or modified to slow up or stop within the body.
• Soft-headed bullets will flatten on impact and some are designed to
fragment
TYPES OF WEAPON
• The nature of firearm wounds varies considerably with the type of
weapon employed.
• In the context of wounding, guns are of two main types;

1. The smooth-bore weapon or ‘shotgun’


• A shotgun consists of smooth metal barrels of relatively wide diameter.
• They fire a variable number of spherical lead shot (pellets), which
emerge from the end (muzzle), from where they gradually diverge in the
form of a long, narrow cone.
• The shotgun, however, at increasingly distant ranges, loses its
destructive nature, and with increasing range of fire over longer
distances, the pellets may penetrate tissues only superficially.

2. The rifled weapon


• Handguns, rifles, air rifles and military weapons differ from shotguns
in that they fire one projectile at a time through a thicker barrel that
has spiral grooves machined on its inner surface.
• The relevance of gun shot wound examination is intended to determine the
following;

■ whether the weapon is smooth-bore or rifled;


■ if rifled, the muzzle velocity of the weapon;
■ the nature of the projectile(s);
■ the nature of the propellant;
■ the degree of choke, if any;
■ the range of discharge;
■ the angle of discharge.
Entrance gunshot wounds
• Contact range
Contact gunshot wounds are recognized by several features;
• Soot and gunpowder residue expelled along with the fired projectile
will stain the wound edges dark gray to black.
• Soot on the skin around the wound indicates that there was some
space between the muzzle of the firearm and the skin in order to allow
the escape of soot.
• The end of the barrel (muzzle) of a firearm can leave an ecchymotic or
abraded muzzle imprint on the skin around a contact gunshot wound.
• Hard contact gunshot wounds, where the muzzle is pressed firmly into
the skin, can result in tears that impart a stellate configuration to the
wound.
• This is most frequently seen in gunshot wounds to the head where the
hot expanding gases forced between the scalp and calvarium are
released by creating tears in the scalp.
Indeterminate range
• The classical indeterminate range entrance gunshot wound has a
central defect/perforation surrounded by a margin of abraded skin.

• An indeterminate range gunshot wound is one that lacks features that


define an intermediate range or a contact gunshot wound, regardless of
the range of fire.
• An intermediary target (including clothing) can shield the skin and
screen or filter out gunpowder and soot.
Intermediate range
• When a gun is fired, pieces of burnt and unburned gunpowder and
soot are expelled along with the projectile.

• Intermediate-range gunshot wounds are defined by the presence of


punctate abrasions caused by pieces of gunpowder striking and
abrading the skin.
• These red punctate abrasions are collectively termed stippling and are
not washed away, although gunpowder deposited on the skin and
embedded in the abrasions can be washed away
• Intermediate range is usually within 2 to 3 feet, but the stippling
pattern is contingent on the firearm and the ammunition.

• Soot can be deposited on the skin around the intermediate-range


gunshot wound and is usually not visible beyond a several-inch radius.
• Increasing the range of fire will increase the area of stippling but
decrease the density of the stippling.
Distinguishing entrance from
exit wounds
• The clothing over a gunshot wound can provide additional information
about the range of fire and differentiate between entry and exit wound
like soot and gunpowder staining on clothes.
• Entry wounds are commonly small and relatively regular than the exit
wounds.
• Wound darkening due to soot accumulation is common for entry
wounds.
• Exit wounds are more irregular than entrance wounds and are not
associated with muzzle imprinting, searing, soot deposition, or
stippling.
• The edges are often torn, resulting in a stellate configuration or ragged
appearance.
• Exiting projectiles that have lost their energy and velocity may just
lacerate the skin or stay subcutaneous.

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