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details about wounds and it's medico legal aspects useful for the medical students as reference

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  1. 1. ABRASION Destruction of the skin-loss of superficial epithelial layers of the skin. Heals rapidly without scar formationCausative agents Blow Fall Finger nail Thorn Tooth-bite
  2. 2. ABRASION
  3. 3. TYPES Scratch Graze Pressure abrasion Impact abrasion
  4. 4. SCRATCH Caused by sharp instrumentsEg- pin, thorn, finger- nail CHARACTER Head-clean seen at beginning) Tail- tagging of skin at end)
  5. 5. GRAZE ABRASIONCAUSATIVE FACTOR traffic accident, fall while running CHARACTER long parallel lines head is clean skin heaped up at tail
  7. 7. PRESSURE ABRASION &IMPACT ABRASIONPRESSURE ABRASION IMPACT ABRASION  CAUSE-impact with rough CAUSE- force object perpendicular to skin Eg – tyre tread, radiator grill, CHARACTER- rope( hanging) Skin crushed Surrounding area contused Eg-ligature mark  THESE TWO COMMONLY (hanging), teeth bite mark KNOWN AS PATTERNED ABRASIONS
  8. 8. AGE OF ABRASION Fresh -bright red color 12-24 hours -scab formation 2 days -scab reddish brown color 4-7 days-epithelium covers After 7 days -scab falls off
  9. 9. M.L.POINTS OF ABRASION Nature of injury  Nature of crime from Site of impact the site of abrasion Direction of force a) Neck-throttling Ext. sign of int. injury b) Around mouth &nose- Patterned abrasion- smothering identifies object c) breast, genitaliaeg)eliptical/circular,2-4 &thighs-sexual assaults marks –teeth bite with d) Site of Crime-presence bruised intervening of mud, grass, straw etc space
  10. 10. ANTE&POST MORTEMABRASIONS Feature Ante mortem Post mortem Bleeding Bleeding surface seen Complete absence of bleeding Scald Forms within a day or Not forming two Site Any where in body Over bony prominences (due to hardening and drying of underlying skin)
  12. 12. BRUSES/CONTUSIONSDefinition- Effusion of blood into the tissues, due to the rupture of subcutaneous vesselsCAUSE -impact of blunt force Eg- stone, fist, stick, bar….CHARACTER Painful swelling & crushing of surrounding tissues Continuity of skin maintained
  13. 13. SIZE -varies from pin head to large Minor trauma cause large bruises in areas where tissues are loose and vascular Eg-face ,scrotum, vagina Moderate violence produce small bruise if tissues are strongly supported, fibrousand covered with thick dermis Eg-scalp, palm, sole, abdomenMARKED ABRASION SEEN on tissues overlying bones on women, children, old age on fair skinned personSMALL BRUISE DEVELOP IN hemophilia, whooping cough, scurvy, leuckaemia
  14. 14. SITE -it may not indicate the site of violence due to gravity shifting of blood eg-blow to forehead shows around the eye -kick to calf muscle shows around ankleSHAPE -usually round -patterned abrasion represents the object -elongated shape - stick, whip, cane -radiator grill shape -in road accident
  15. 15. AGE OF BRUISE Fresh -red Hours to 3days - blue 4thday -blue black/brown 4-6 days -greenish 7-12 days -yellow 2 weeks -normalM.L.POINTS -patterned bruise indicate weapon or object -size indicate degree of violence -age of injury -manner of assault (throttling-seen neck,) -contusion to internal organs lead to death
  16. 16. DIFFERENCES B/W ACCIDENTAL,HOMICIDALAND SELFINFLATED BRUISESAccidental Homicidal Self inflatedPresence of Size and Bruise formed by chitrakanatural items shape of Color-dark brownseen on the bruise will Margins –with vesiclessite of crime corresponlike sand ds to the Surrounding tissues-,gravel weapon Red and inflamed used Scraping of mark responds to the test to identify the material
  17. 17. DIFFERENCE B/W ANTE MORTEM &POST MORTEM BRUISE Features Ante mortem Post mortem Swelling Present Absent Color change Present Absent In case of Present any Present only severe trauma where of body body prominent area
  18. 18. DIFFERENCE B/W TRUE AND ARTIFICIAL BRUISE Feature Artificial bruise True bruise1 Cause Arka / bhallataka juice Physical violence2 Situation Accessible area Anywhere3 Shape Irregular Round4 Margins Regular, well defined, small Diffuse, irregular,no vesicles vesicles5 Color Dark brown Typical changes6 Inflammation Of surrounding area At the site7 Contents Acid serum Blood8 Itching Present Absent9 Vesicles May found on finger tip Absent &other part of body
  19. 19. INCISED WOUNDS/SLASH WOUNDdefinition- it’s a clean cut through the tissuesCAUSE by sharp cutting weapons eg-knife, scalpel
  20. 20. CHARACTER Edges are clean cut, well defined & everted Width is greater than the edge of weapon (due to retraction) Length is greater than width or depth Shape- spindle shaped Hemorrhage is more vessels are clean cut) Deeper at head -start due to more pressure) Shallow at tail A curved weapon like sickle produce a stab first then an incised one
  21. 21. AGE OF WOUND M.L.POINTS  size indicate degree of12 hours-edges red, swollen and violence adherent  age of injury24 hours-vascular buds  direction of force by begins detecting head36 hours-capillary net  foreign bodies on work wound leads to crime complete site3-5 days-vessels thickened, obliterations start1-2 weeks-scar tissue
  22. 22. CHOP WOUND A type of incised wound caused by cutting edge of fairly heavy weapon(axe)CHARACTER Margin sharp Margin bruised and abraded Dimension corresponds to the cross section of blade Complete or incomplete amputation of fingers or bones Usually homicidal Accidental by power fans, ship propellers etc…
  23. 23. SUICIDAL INCISED WOUNDS Multiple& parallel in any one area Seen on accessible areas Hesitation marks /tentative cuts seenHesitation marks-multiple, small, superficial cuts seen at the head of woundCUT THROAT
  24. 24. DIFFERENCE B/W SUICIDAL AND HOMICIDAL CUT-THROATWOUND Sl no Feature Suicidal Homicidal 1 Situation Left side ,passing front(rt On sides hand) 2 Level Above thyroid cartilage On or below 3 Direction Above downwards &lt to rt Transverse/below upwards 4 Edges Ragged due to hesitation Sharp &clean cut mark 5 Hesitation cuts Multiple at head Absent 6 Severity Less severe More severe 7 Tailing Present Absent 8 Vessels Carotid art do not injured Jugular and carotid cut
  25. 25. 9 No of wound Multiple (20-30),superficial Not multiple ,deep level10 Defense wound Absent Present11 Wounds of other Incised may be wrist, thigh, Severe injury over part groin head12 Weapons Present at site Absent13 Cadaveric spasm Weapon may grasped Fragments of cloth, hair, etc14 Blood stain If in front of body &cloths If sleep on either sides, palms15 Cloths Not damaged May cut, disarrangement, tear16 Circumstantial Quiet, suicidal note, in front of Disturbance at scene mirror
  27. 27. STAB WOUND/PUNCTURED WOUND This type wound penetrate skin and deeper tissuesCAUSE- sharp objects like knife, dagger, arrow,spear,needlePENETRATE WOUND- if enters body cavityPERFORATED WOUND if weapon comes out on other side it have two type of wounds -ENTRY WOUND Large Inverted -EXIT WOUND Small Everted
  28. 28. CHARACTERS Length less than width of weapon Depth is greater than length or width Margins clear cut without abrasion Shape corresponds to the weapon Elliptical -single edged weapon Circular -round weapon Cruciform -square weapon Direction can made out
  29. 29. CONCEALED PUNCTURE WOUND Seen on canceled part of body Eg-vagina,rectum,eye,nostrils, nape of neck,fontanelle(brugma region)DEATH RESULT- needle push to brain through fontanelles or cantus of eye pin push into medulla through nape of neckML POINTS Direction of wound detect whether it is suicidal/homicidal/accidental Position of victim give inference position of accused Site of wound detect type of death Condition of clothing detect any violence
  30. 30. LACERATION WOUND Tear or splits of skin and subcutaneous tissues by the blow from blunt objects. Eg-hard projecting surfaces, machinery & railway accidents, wheel crushing
  31. 31. CHARACTER OF LACERATION WOUND Margins are irregular and ragged Ends are torn Margins or subcutaneous tissues contused Deeper tissues are irregularly torn Hair bulbs crushed Hemorrhage is less (irregularly torn vessels) Depth varies Shape and size does not corresponds to object Skin opposite to the force is torn Foreign bodies may present Underlying bones likely to be fractured Internal hemorrhage may be profuse and lethal TYPES -4 TYPES Split laceration Stretch laceration Avulsion Cut laceration (chop wound)
  32. 32. SPLIT LACERATION CAUSE crushing skin between 2 hard objects CHARACTER Incised like wounds seen Seen areas like -areas where skin tightly stretched over bones -areas where subcutaneous tissues are less Eg-scalp, eyebrow, cheek bones, chin
  33. 33. STRETCH LACERATION CAUSE fixed skin when get over stretched Eg-run over motor accident, compound fractureAVULSION LACERATION CAUSE grinding compression by weight Eg-lorry wheel passing over a limbCUT LACERATION CAUSE blow with heavy sharp edged weapon Eg- axe
  34. 34. DIFFERENCE B/W ANTEMORTEM AND POST MPRTEMLACERATIONSi no Feature Ante mortem Post mortem1 Contusion Present Absent2 Everson Present Absent3 Gaping of margins Present Absent4 Vital reaction Present Absent
  35. 35. ML POINTS OF LACERATION WOUND Direction of force can detect Site of crime or accident from the foreign bodies in wound Mode of death Lesion whether ante mortem or post mortem Approximate cause can drawn
  36. 36. DEFENCE WOUNDS Wound received by victim during attack to save himself by raising hand and grasping weapon SITES- Usually on palm, ulnar border of forearm, back of hands TYPE OF WOUND  Depend on the weapon used varies  Contusion, Abrasion, Laceration, Incised, Stab  It indicate homicide CONDITIONS FOR THE ABSENCE OFDEFENSE WOUND  Attack at victim is unconscious  Attacked suddenly
  37. 37. SELF-INFLATED AND FABRICATED WOUNDSYNONYMS -FICTITIOUS / FORGED WOUNDS Wounds produced by a person by himself Wounds produced by some other on a person with his consent AIM Falsely blame an enemy for revenge or jealousyCHARACTER Mostly incised or stab wounds Produce by application of some irritant juices or burns Laceration and contusions are rare Site will be exposed and accessible areas of bodyEg front of wrist, neck, front or out side of lt arm, front or outer of thigh, Front of chest, abdomen Injuries are multiple and superficial Cloths are not damaged
  38. 38. FIRE ARM WOUND
  39. 39. FIRE ARM CONSIST OF Hollow metal barrel Front open end – Muzzle end Closed back end- Breech end Posterior part- ButtCLASSIFICATION OF FIRE ARM1) SMOOTH –BORED WEAPON(SHORT-GUN) single barrel double barrel repeating or self loading2) RIFLED WEAPONS rifle a)0.22 rifles b)military rifles c)air –rifles single shot pistols automatic pistols revolver automatic weapons
  40. 40. SMOOTH –BORED WEAPON(SHORT-GUN) repeating or self loadingsingle barrel double barrel
  41. 41. TECHNICAL TERMS1)CALIBER / GAUGE Internal dimension of barrel Measured in inches or centimeters Measured with the help of lead ball’s size which fits the barrel MEASURING THE DIAMETER OF BARREL
  42. 42. 2)CHOCKING OF GUN Distal3/4th of barrel is narrow CHOCKING OF GUN Degree of narrowing is chocking It’s of 3 types -full chock -half chock -quarter chockBENEFITS OF CHOCKING Chocking increases explosive force velocity of shot Chocking less the rate of spread of shot
  43. 43. 3)RIFLING In some weapons the bore is Marked internally with spiral grooves No: of spirals varies from 4 -7 They run parallel to each other but twisted spirally They extended from breech end to muzzle end These grooves are known as rifling The ridges between the grooves are known as lands
  44. 44. 4)CARTRIDGE Ammunition (projectiles to be fired from a gun) consisting of a cylindrical casing containing an explosive charge and a bullet; fired from a rifle or handgun Its of two types a) shot-gun cartridge b) cartridge for rifled weapon
  45. 45. a) SHORT GUN CARTRIDGE Length 5-7 cm The case consist of -short metallic cylinder it is rimmed to keep in position it help the extraction -long card board cylinder CASE IS FILLED FROM BASE TO UP Percussion cap in centre of base (containing priming mixture) Gun powder Felt wad with cardboard disc front & behind Shot Cardboard discFelt wad =Hold the powder and allow sufficient buildup of gas pressure when fired
  46. 46. b) CARTRIDGE FOR RIFLED WEAPON It consist of Elongated metal cylinder (it is rimmed except in automatic weapon) Distal end tightly grips base of bullet The powder charge lies between detonator and bullet Bullets are conical in shape
  47. 47. WOUNDS FROM SHOT –GUN The wound depends on Distance from which weapon fired Size of shot Nature of explosive The gun Elasticity of skin and organs Fragmentation of bullet
  48. 48. WOUND DEPEND S ON THE DISTANCE OF WEAPON If the gun fired in contact or a few inches of body a) Shot enters in one mass as single bullet b) Large irregular entry wound c) Margins of the wound bruised d) Deeper tissues are ruptured and lacerated e) Unburned powder particles found in wound f) Unburned powder embedded in surrounding skin produce tattooing g) Margins of the wound are burnt by flame h) Margins of the wound are black due to smoke i) Shape of the burned area depends on the angle of fire Circular-if fired at rt angle Oval -if fired at a different angle j) If body covered burning, blackening & tattooing seen not over skin k) On head contact wound cause Large, irregular holes on skull Fissured fractures or bursting open with scattered
  49. 49. If the gun within 6 inches tissues are signed and blackened over broader area margins are cleanIf the gun between 1-3 feet single round wound 1-1.5 inches diameter Irregular edges 1-3 inches Tissues are much damaged due to the spreading of shotIf the gun above 3 feet Shot begin to spreadIf the gun at 6 feet Wound is surrounded by separate opening in an area of 2 inchesIf the gun at 12 feet Shot spreads widely and produce separate opening in an area of 4 inchesIf the gun at 20 yards Only skin or muscle penetrate 12 feet
  50. 50. B) SIZE OF SHOT Smaller shot-minute irregular edged wound Large shot -pass deep to bodyC) NATURE OF EXPLOSIVE Smokeless powder - less blackening and tattooing Black powder - marked blackening and tattooingD) THE GUN WOUND DEPEND UPON 1) Length of barrel 2) Bore of barrel 3) Chocking of barrel The spread of shot in inches is roughly equal to range of fire in yards
  51. 51. WOUNDS FROM REVOLVERS OR PISTOLSDISCHARGES FROM THE GUN Gases, Smoke, Flame, Powder, Metallic particles. Flame extends - 2-3 inches Smoke extends -12 inches Powder granules -18-24 inches Metallic particles -18-24 inchesShots are of4 types depends on the distance of the weapon  contact shot  close shot  near shot  distant shot
  52. 52. CONTACT SHOT All the discharges from the gun pass into the wound Burning, blackening are not seen around wound entrance The wound is large Shape of wound Irregular, Stellate, Cruciate Elliptical, Triangular These different shapes due to the expansion of gases in the tissues On head the wound will be Large and cruciform with Everted margins (due to the expansion of gases in between scalp and skull) Skull bone burst open Abdominal wound produce cavitations The imprint of muzzle of gun may seen as patterned abrasion The tissue around the bullet track may pink color (CO contained gas)
  53. 53. 2) CLOSE SHOT The range is 1-3 inches Very close or contact range is called Point Blank Wound is round Margins singed, black and tattooed Hair are singed (burned) As bullet enters the body skin is inverted, stretched and splits The gyrated bullet (revolve around a fixed point or axis) produce abrasion round the wound due to rubbing of bullet with skin Collar-the elevated area seen around the wound produce by the bullet Since abrasion is present around the wound it is known as Abrasion collar
  54. 54. Abrasion collar-Type of bullet -gyrated bullet Due to rubbing with skin abrasion seen around the wound It is of two types Grease/dirt collar Contusion collaGrease/dirt collar- Type of bullet -lubricated or soiled bullet Grease or dirt attached to the skin around the hole These may seen over the abrasionContusion collar- Type of bullet - gyrated bullet Contusion also may seen along with abrasion Contusion seen over the margins
  55. 55. If the weapon fired at right angle The wound become circular with abraded collar aroundIf the weapon fired at an angleo An eccentric hole with abraded collaro Collar will be wider on one side than othero Wider area indicates the direction of bulletIf the weapon fired from a distance of 6 inches wound is round size of wound represents the size of bullet margins show bruising, blackening and tattooing it will not produce burning
  56. 56. 3) NEAR SHOT Range of shot -12-18 inches Wound is smaller than size of bullet Blackening and tattooing seen over wide area Burning and singing is not seen
  57. 57. 4) DISTANT SHOT Range of shot -above 18 inches Wound is round and smaller than bullet Blackening and tattooing absent Abrasion collar present
  59. 59. Sl Feature Entrance wound Exit woundno1 Size Smaller than bullet except bigger than bullet in contact2 Edges Inverted Everted , torn3 Abrasion and grease Present Absent collar4 Burning, blackening May present Absent and tattooing5 Bleeding Less More6 Tissues May cherry red due to CO no color change7 Fibers of cloth May found Absent8 Metal ring May seen around wound Absent9 Skull Punched in hole in outer Punched out opening in inner table; table
  60. 60. RICOCHET BULLETRicochet - To rebound at least once from a surface.Ricochet bullet is that which strikes an intervening object first, then rebounds, then hit the target aimed. It occurs with low quality fir arms If the velocity of bullet is lowWhen bullet hit hard, flat surface it may deformed then if it hit body the wound Large Irregularly oval, triangular or cruciate Abrasion collar, burning, blackening … are absent Abrasion and contusion of skin may seen
  61. 61. TANDEM BULLET Two bullets inside the body with single entrance wound Multiple bullets fired separately entering through a single entrance SITE OF SELECTION FOR SUICIDE Temple, Centre of fore head, Roof of mouth, Midline behind the chin, Front of chest
  62. 62. BOMB EXPLOSION WOUNDSIf burst at close range Expanding gases shatter or obliterate bodyIf burst at distance The person is thrown to a distance Blunt force injuries will develop Burn may be develop Death may occur due to CO if occur in room Internal organs show congestion, minute hemorrhage & rupture
  63. 63. FRACTURE OF SKULL There are 7 types 1) Fissured fracture 2) Depressed fracture 3) Comminuted fracture 4) Pond or indented fracture 5) Gutter fracture 6) Ring or foramen fracture 7) Penetrating fracture
  64. 64. 1) FISSURED FRACTURECAUSATIVE FACTOR physical violence to the head fall on feet or buttocksCHARACTER These are cracks or linear fractures It may involve one or both tables Fracture starts at point of impact It runs parallel to direction of force If head is supported the fracture starts at counter pressure* area *COUNTER PRESSURE -Force or pressure that acts in a contrary direction to some other opposing pressure. In bilateral compression it may start at vertex or base
  65. 65. 2) DEPRESSED FRACTURECAUSATIVE FACTOR Heavy weapon with small striking surface Eg-stick, stone, CHARACTER Fractured bone driven inward Shape of wound indicate the type of weapon Eg-hammer – fracture shape is circular
  66. 66. 3) COMMINUTED FRACTURECAUSATIVE FACTOR Traffic accident Blow with weapons with large striking surface Fall from heightCHARACTER Bone broken into pieces
  67. 67. 4) POND OR INDENTED FRACTURE CHARACTER Seen only in infants. Bone is indented* *Make a dent or depression in.5) GUTTER FRACTURE GUTTER FRACTURECAUSATIVE FACTOR Glancing bullet woundCHARACTER Thickness of the wound is removed
  68. 68. 6) RING OR FORAMEN FRACTURECAUSATIVE FACTOR Fall from height on feet or buttocks Sudden violent turn of head on spineCHARACTER Fissured fracture encircles the skull It separate ant. 1/3rd with post.1/3rd of skull It also seen in base encircling foramen magnum,& separate skull from spine
  69. 69. 7) PENETRATING FRACTURECAUSATIVE FACTOR Sharp weapons like knife, daggerCHARACTER Clean-cut opening Penetrating the skull
  70. 70. CONTRE-COUP INJURIESCOUP INJURY The injury seen under the area of impactCONTRE-COUP INJURIES The injury which is situated opposite side of area of impact These injuries seen only when the head is free to moveCAUSATIVE FACTOR Local distortion of head due to blowEg-occipital injuries produce lesions atbase of frontal lobe or tip of temporal lobe
  71. 71. CONCUSSION OF BRAIN/ STUNNING OF HEAD Diffuse injury to nerve cells and fibers due to violence caused concussion It is an un-consciousness produced by violence applied to skull It resolves spontaneously After some time patient again unconscious There will be an interval between two unconsciousness times called lucid interval At autopsy no lesions are found in brain (petechial hemorrhage seen some cases)TYPES . Concussion is divided into two groups: Simple and Complex. Simple concussion: The symptoms gradually resolve The patient returns to normal function in 7 - 10 days. Complex concussion: The symptoms persist and thought processes are affected. Patients with repeated concussions fall