Wounds

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Wounds

• Definition
• Classification of wounds
• Anatomical
• Legal classification
• Medico- legal classification

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Anatomical classification

• Skin
• bone
• Muscle
• Mucous membrane
• Hollow organ

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Legal classification

• Simple wound
• Dangerous wound
• Fatal wound

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3-Medico- legal classification

• Sharp
• Blunt
• Firearm.
• Physical injuries.

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A-Wounds caused by sharp instruments

• Incised (Cut) wounds.
• Stab wounds.
• Stab penetrating wounds.
• NB
• Transfixing wounds.
• Defense wounds

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I-Incised (cut) wound

• Definition
• Characters
• 1- The edges
• 2- The length
• 3- Gaping of the edges
• 4- Bleeding
• 5- Liability to sepsis
• 6- Healing

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Its age can be determined to know the time of its
infliction by histological examination

• 30 minutes 4 hours
• Margination of polymorph nuclear leucocytes
• 48 hours
• Pus may be present if sepsis occurs.
• 10-15 days
• Complete healing by primary intention if no
  sepsis.

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Its age can be determined to know the time of its
infliction by histological examination

• 3 weeks Red scar .
• 3 months Scar becomes coppery.
• 6 months Scar is thin and pale,

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II- Stab wound

• Definition
• Unibladed knife or Bibladed knife
• Characters
• More deep than long
• The edges
• The shape of the wound may be changed if
• They are very dangerous
• A broken tip of the weapon may be found in the
  wound .

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Different Blades
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Types of stab wounds

• Ordinary stab wounds.
• Punctured wounds.
• Penetrating wounds (3PMS) .
• Transfixing wounds .

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Hemopericardium
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Fabricated wound

• Definition
• Characters
• Aims

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Defense wounds

• Definition
• 1- Injuries sustained by grasping the weapon
• 2- Injuries sustained during raising the hand

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Defense wounds
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2- Wounds caused by blunt instruments

• Abrasions.
• Bruises (contusion).
• Lacerations.

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1-Abrasion

• Definition
• Causative instrument
• Types
• linear
• Sliding
• Pressure
• Impact
• Bite

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ML importance of abrasions

• Violence
• Its shape
• Its site
• Its age
• Cut and contused wounds

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2- Contusions

• Definition
• Types ecchymosis bruise-contusion -

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Factor affecting size of contusion

• Age
• Sex
• Color of the skin.
• Gravity.
• Blood Diseases
• Force
• Onset of death
• ML importance

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Age of contusion

• 1st day red in color (oxy HB)
• After 1-3 days blue ( reduced Hb).
• After 2-5 days green ( biliverdin)
• After 5-8 days yellow (bilirubin)
• Bruises fade away ( heal) in 2-3 weeks.

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Color changes
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Bruises may be dangerous if

• They occur in a trigger zone.
• They are extensive.
• They become infected
• They hide a more serious injury e.g. rupture
  organ.

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3-Contused wounds

• Definition
• Characters simulate cut wounds

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Deference between cut and contused W

• The edges
• Instruments
• Hair
• Bleeding
• Liability to sepsis
• Abrasion contusion.
• Healing
• BRIDGING OF Tissues

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Complications of wounds

• 1- Neurogenic or primary shock.
• 2- Traumatic shock (secondary shock).
• 3- Hemorrhage.
• 4- Embolism
• 5- Infection.
• 6- Crush syndrome.

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1- Neurogenic or primary shock.

• A- Parasympathetic inhibition of the circulation
  (vagal inhibition). Or
• B- Sympathetico-adrinal stimulation of the
  circulation.

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2- Traumatic shock (secondary shock).

• It occurs due to
• release of histamine like substance from the
  severely lacerated tissues that causes
• increase in the capillary permeability
• and loss of capillary tone

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3- Hemorrhage (oligaemic shock)

• Factors affecting the gravity of hemorrhage
• a- Amount of blood lost
• b- Rate of hemorrhage
• c-site of hemorrhage
• d- General condition of the patient
• e- sex

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Types of hemorrhage

• 1- Primary hemorrhage
• It is directly due to the wound, it is either
  internal or external.
• 2- Secondary hemorrhage
• 3-Reactionary hemorrhage

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4- Embolism

• 1- Air embolism
• a- venous air embolism
• b- arterial air embolism
• 2- Thromboembolism
• 3- Fat embolism

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5- Infection.

• Contused and lacerated wounds are the most liable
  to severe infection particularly,
• tetanus and
• Gangrene
• due to devitalized tissue of the wounds.

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6- Crush syndrome

• Severe crushing of muscles ? liberation of
  myoglobin? blocking of renal tubules? acute renal
  failure

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Thank you