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Bruises lacerations

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Bruises lacerations

  1. 1. BRUISES; LACERATIONS
  2. 2. OUTLINE  BRUISES Definition Classification Characteristics Factors modifying Colour changes in a bruise Age of a bruise Medicolegal significance  LACERATIONS Definition Classification Characteristics Medicolegal factors  BRUISES Vs LACERATIONS
  3. 3. BRUISES(CONTUSIONS)
  4. 4. BRUISES(CONTUSIONS)  DEFINITION;- “A bruise signifies haemorrhage into the skin, the subcutaneous tissues, or deeper tissues.It is due to an infiltration or extravasation of blood into the tissues, following rupture of small vessels, as a result of blunt force.”
  5. 5. BRUISES(CONTUSIONS)  CLASSIFICATION;- 1.Intradermal Bruise 2.Subcutaneous Bruise 3.Deep Bruise
  6. 6. BRUISES(CONTUSIONS)  INTRADERMAL BRUISE:- When a bruise is made by impact with a patterned object, the haemmorhage may lie in the immediate subepidermal layer & its pattern may correspond to the form of the object or the weapon causing it, e.g, whips, canes, bicycle chain etc.
  7. 7. INTRADERMAL BRUISE
  8. 8. BRUISES(CONTUSIONS)  SUBCUTANEOUS BRUISE:- The usual bruise from a blunt impact is situated in subcutaneous tissues. It is somewhat blurred at the edges & raised above the skin surface due to infiltration of blood in subcutaneous tissues.
  9. 9. SUCUTANEOUS BRUISE
  10. 10. BRUISES(CONTUSIONS) • DEEP BRUISE:- This signifies bleeding deeper to the subcutaneous tissues & some swelling may be apparent when the opposite limb or part of the body is compared with the injured area. It may take hours or one or two days to appear at the surface.
  11. 11. DEEP BRUISE
  12. 12. BRUISES(CONTUSIONS) • CHARACTERISTICS:- 1. May not always be present at the site of impact. 2. The greater the force or violence used, the more extensive is the bruise. 3. Spreads due to continued extravasation & consequently occupies a wider area, it is not possible to assess the area of impact & severity of violence in such cases.
  13. 13. BRUISES(CONTUSIONS) • FACTORS MODIFYING APPEARANCE OF A BRUISE:- 1. Site of injury 2. Vascularity of the part 3. Age 4. Sex 5. Colour of skin 6. Natural disease 7. Gravitational shifting of blood
  14. 14. BRUISES(CONTUSIONS) • COLOUR CHANGES & AGE OF A BRUISE:- After a bruise has appeared, it tends to get smaller from periphery to center & passes through a series of colour changes:- 1. Red Immediately after infliction 2. Dusky purple/ Black Fairly fresh(1/2-8hrs) 3. Blue 8hrs-4days to 2 weeks 4. Green 4days-1 or 3 weeks 5. Yellow 7days to 3 weeks 6. Disappears 1-4weeks
  15. 15. BRUISES(CONTUSIONS) • MEDICOLEGAL SIGNIFICANCE:- Bruises provide information in regard to:- 1. Identification of the object causing the injury. 2. Degree of violence. 3. Cause of injury. 4. Time of injury. 5. Possibility of infection.
  16. 16. LACERATIONS
  17. 17. LACERATIONS  DEFINITION:- “ A laceration is a wound in which the skin, mucosa or underlaying tissues are torn as a result of application of blunt force”
  18. 18. LACERATIONS  CLASSIFICATION:- 1. Split laceration 2. Stretch lacerations 3. Avulsion 4. Tears 5. Internal laceration
  19. 19. LACERATIONS 1. SPLIT LACERATIONS:- The injury is due to crushing of the skin between two hard objects, viz, underlaying bone & the object responsible for injury.The result is linear split in the skin & injury may simulate an incised wound.They are commnly found in parts overlaying bones without much tissue in between i.e on scalp, face, hands & lower legs.
  20. 20. SPLIT LACERATION
  21. 21. LACERATIONS 2. STRETCH LACERATIONS:- This is due to over-stretching of the skin till it splits & produces a flap.Such an injury is produced by a blunt tangential impact, e.g, laceration of the scalp when the head strikes a motor car wind screen.It is also produced when sudden deformaity of a bone occurs after a fracture.
  22. 22. STRETCH LACERATION
  23. 23. LACERATIONS 3. AVULSION:- This is due to grinding compression of tissues to such an extend as to separate the skin from deeper structurs(degloving of skin) & crush the muscles underneath.It results from horizontal crushing impact such as by lorry wheel or by machinery.
  24. 24. AVULSION
  25. 25. LACERATIONS 4. TEARS:- The injury results from irregular tearing of skin & tissues. These are due to impact against irregular or sharp objects, e.g motor car door handles, blows from broken bottles.
  26. 26. TEARS
  27. 27. LACERATIONS 5. INTERNAL LACERATIONS:- When the blunt force exceeds the tensile strength & elasticity of an internal organ or tissue, laceration may result in such organ without any surface tear.
  28. 28. INTERNAL LACERATION
  29. 29. LACERATIONS • CHARACTARISTICS:- 1. The edges are ragged, irregular, & bruised. 2. The margins are abraded. 3. Hair follicles & blood vessles are seen to have been crushed. 4. External haemorrhage not pronounced. 5. Foreign material found in the wound. 6. Surface appears depressed.
  30. 30. LACERATIONS  MEDICOLEGAL FACTORS:- In examination of a victim the following essentials should be kept in mind:- 1. External evidence of Injury may be minimal or absent even massive internal injuries may be present. 2. Tissues will bleed less. 3. Foreign material or trace evidence indicate agent responsible. 4. Pattern of injury. 5. Suicidal lacerations. 6. Homocidal lacerations. 7. Accidental lacerations.
  31. 31. BRUISES Vs LACERATIONS
  32. 32. BRUISES Vs LACERATIONS BRUISES LACERATIONS  Skin, mucosa, or underlaying tissues remain intact.  Haemorrhage into skin, subcutaneous tissues, or deeper tissues.  Closed wound  May not always be present at the site of impact.  Foregin bodies not present.  Skin, mucosa, or underlaying tissues are torn.  Haemorrhage not pronounced.  Open wound  Always present at the site of impact.  Foregin bodies frequently present.

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