Definitions, Biophysics and Classifications of wounding
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Anatomy of Skin Biophysics of Trauma Definitions and Classifications of wounds (legal, medicolegal)
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Definitions, Biophysics and Classifications of wounding
- 1. Classification & Description of Wounding Dr. Mamdouh K. Zaki Doctorate of Forensic Medicine Jeddah Forensic Medicine Center MOH – Saudi Arabia Ministry Of Health Directorate of Health Affairs Jeddah Forensic Medicine Center
- 3. Forensic Anatomy of The Skin Skin Layers 1. Epidermis ةَرَشَبال -Stratum Basale -Stratum Spinosum -Stratum Granulosum -Stratum Lucidum -Stratum Corneum (Great Variability) 2. Dermis ةَمَدَاأل 3. Hypodermis ةَمْحُّلال ( دْلِجال َتْحَت ُةَسٌجَّنال )
- 4. Epidermis ةَرَشَبال = Protective layer of the skin = Composed of Stratified Squamous Epithelium = Thickness varies from 0.007 mm to 0.12mm. = Thickest over palms and soles = Thinnest over protected areas
- 5. Epidermis ةَرَشَبال 1-Stratum Corneum - Real protective layer of the skin = cornified - 25-30 layers of flattened scale like residues of cells, due to keratinization, flattening & hardening of underlying layers of cells. 2-Stratum Lucidum - Present in the lips & thickened palms & soles. 3-Stratum Granulosum - layers of flattened cells. Granular due to keratinization . Stratum Germinativum 4-Stratum Spinosum - Different shape of keratinocytes. 5-Stratum Basale - Single layer of cells in contact with dermis, but 4 types (Keratinocytes, melanocytes, tactile cells, granular dendrocytes “Langerhans cells”. - Time for a basal cells to reach the surface = 6 – 8 weeks.
- 6. Dermis ةَمَدَاأل - Deeper and Thicker layer. - Highly vascular & Glandular. - Contains nerve endings and hair follicles. - Blood vessels nourishes living layers of epidermis. - Numerous collagenous, elastic and reticular fibers = support to the skin. - Radiation of fibers in definite directions =lines of tension on skin surface =Cleavage lines of Langer. Of Medicolegal Importance.
- 7. Dermis ةَمَدَاأل 1-Stratum Papillarosum (papillary layer) - In contact with the dermis. - Numerous projections (papillae) extend to form this layer into the epidermis. - Papillae form the base for the friction ridges on the fingers and toes. Medicolegal Importance 2-Stratum Reticularosum: - Lower layer, below mitotic basal layer. Medicolegal Importance
- 9. قوةى FO R C E ى المادةىأوىاألداةى ى المدببةىلإلصابة ى القوة إمتصاص Absor bance ى Resilience & Elasticity of soft tissues الرخوة األنسجة ةَنروُمو أقلمة ( العضالت ،الجلد ) Adapt at i on ى Rigid Strength of Skeletal framework ًالعظم الهٌكل وصالبة بقوة المقاومة R esi st ance Biophysics of Wounding
- 11. 1. Nature of Weapons / Objects Broad surface / blunt object over a dissipated = force large area = Less Damage Biophysics of Wounding
- 12. Break of weapon on the body ((Common false belief)) = loss of energy = less damage Biophysics of Wounding 1. Nature of Weapons / Objects
- 13. 2. Amount of Energy discharged during impact Biophysics of Wounding
- 14. Moving Body Force is Rigidity of Stationary object or surface Usually a combination of both forces Less or more Damage Moving Object Force is Inertia of the body 3. Conditions under which the energy was discharged Biophysics of Wounding
- 15. A. Skin More Pliable, little elastic, readily affected. Blunt Trauma Flattening or elongation of cells less damaged than underlying SC tissue. 4. Nature of Tissue affected Biophysics of Wounding
- 16. A. Skin 4. Nature of Tissue affected Biophysics of Wounding Splits easily when crushed against rigid bone. Stab wound resistance of skin is more than muscle.
- 17. Plastic and More Pliable. Ordinary Blunt Trauma acts as a cushion. Severe Trauma SC tissue crushed Fat droplets displacement tear of connective tissue framework bruising or laceration. 4. Nature of Tissue affected Biophysics of Wounding
- 18. High Elasticity ةَنروُمال and Plasticity ةٌَِّفٌَُّكَتال . Blunt Trauma Resist up to certain extent. If exceeding its elasticity tear avulsion crushed torn stretch. 4. Nature of Tissue affected Biophysics of Wounding
- 19. Rigid and Elastic ةَنروُمال. Blunt Trauma bend 1st without fracture & recoil. If exceeding its elasticity ةَنروُمال break # at the point of maximum convexity (e.g. greenstick #). Force against greater surface extensive bending strains multiple bone fragments. Twisting strain Spiral #. 4. Nature of Tissue affected Biophysics of Wounding
- 20. • الخشونة درجة ،ةَنوٌُُلال درجة ،الراضة األدوات ،الحادة األدوات / الممٌزات ،األداة بحدود االنتظام درجة ،والمساحة األبعاد ،ةَسَالَمال الفردٌة Nature of Weapons / Objects األدوات طبٌعة / األسلحة • Kinetic Energy = ½ MV2 • الكتلة مع ًاٌعكس تتناسب ةٌِّكَرَالح ةَقالطا • مع ًاٌعكس تتناسب ةٌِّكَرَالح ةَقالطا ( السرعة ) 2 Amount of Energy discharged during impact التأثٌر عند غةَرْفَمال الطاقة كمٌة / التصادم • العكس أو األداة إلى الجسم حركة تأثٌر • مضادٌن اتجاهٌن ًف كالهما واألغلب Conditions under which the energy was discharged غةَرْفَمال الطاقة صاحبت ًالت الظروف • الجلد ( من الحاد للسالح مقاومة وأكثر المرونة قلٌل ولكنه ِاع َ وِْطم العضالت ) الجلد تحت الرخوة األنسجة ، ( ةٌِّاع َ وِْطم أكثر - وسادة ) ، العضالت ( ومطواعٌة مرونة األكثر ) العظام ، ( من قلٌل مع الصالبة المرونة ) Nature of Tissue affected الطاقة لتلك المعرضة األنسجة طبٌعة • ،ًالعظم البروز مقابل ،الفخذٌن ،العضدٌن ،الظهر ،الصدر ،الرأس .... الخ Site of Injury / infliction بالجسم اإلصابة موضع Biophysics of Wounding: Summary
- 22. In medical recognition, Wounding, Injury & Trauma = the same, BUT: A wound is a solution of the natural continuity of any of the tissues of the living body (No reference to the effusion of blood, nature of the tissue, the cause & whether caused by diseases or not), thus Simple and Generalized. Wound Smith (1948) A wound means “damage to any part of the body by the application of violence” or ‘‘causing serious bodily harm’ (acc. to many Jurisdictions). Thus, covers any injury to any tissue or organ. Wound Knight (1991) Means an insult to the living tissue. It applies also to emotional or mental stress. Trauma Means any harm whatever illegally caused to any person, on body, mind, reputation, or property. Injury Definitions
- 23. Definitions Essentially, a WOUND is damage to the tissues of the body caused by MECHANICAL FORCE. Knight, 1997 Excludes damage from heat, cold, electricity, corrosives and poisons. Includes beating, punching, kicking, biting, knifing, strangling, shooting, explosives, falling and injury from machinery and vehicles. But
- 24. الكٌفٌة Manner جنائٌة Homicidal النفس إٌذاء االفتعالٌة Self inflicted عرضٌة Accidental مصنفة غٌر Unclassified محددة غٌر Unknown * اإلصابة إلحاق كيفية Manner of infliction
- 25. Legal Classification 1. Simple wounds بسٌطة جروح: superficial, minor These are wounds that heal in less that 20 days without (i) causing permanent deformity and (ii) surgical interference not needed. 2. Dangerous wounds خطٌرة جروح , major, wide, deep, lacerated, vital area, prone for complications: Wounds that heal in more than 20 days. May heal in less than 20 days but leave permanent infirmity and need surgical interference for healing. 3. Fatal wounds ممٌتة جروح: Wounds that end by death of the victim either immediately or shortly afterwards, provided that, death is not due to: Neglecting of victim in seeking treatment or Fault of surgeon or anesthetist. Discussion
- 28. A. Mechanical Injuries: 1. Blunt Force أدوات أو قوة راضة : - Abrasion سحجة / سحجات - Contusion / bruise كدمة / كدمات - Laceration جرح ًرض - Facture / dislocation of bone/teeth كسر / خلع / انزالق ... 2. Sharp edged weapons أدوات ذات حافة حادة : - Incised and Chop wounds جرح ًقطع / جرح ًقطع ًرض - Stab and punctured wounds جروح طعنٌة ووخزٌة 3. Firearm weapons أسلحة نارٌة : acc. to the weapon (sometimes Miscell.) جروح نارٌة B. Thermal Injuries: 1. Due to Heat: -Generalized effects: heat stroke, heat exhaustion انهاك حراري / ضربة حرارٌة -Localized effects: burns, scalds, lightening, electrocution. حروق ،نارٌة ،سلقٌة صعق ًكهربائ أو صعق بالبرق 2. Due to Cold: -Generalized effects: hypothermia ُضْفَخ ةَرارَالح -Localized effects: frostbite (dry جٌِْلْثَت) , trench foot (wet ُمَدَق ِقدناَالخ ) C. Chemical Injuries: due to corrosives or irritants إصابات ناتجة عن التعرض لمواد كٌمٌائٌة أو ةَجٌَِّهُم D. Miscellaneous: irradiation injuries, blast injuries إصابات ناتجة عن التعرض عُّعَشَتلل أو االنفجارات Classification Acc. To Causative force/Agent/instrument
- 29. متنوعة آلٌات متزامنة Miscellaneous إصابات النارٌة األعٌرة الناتجة االصابات أو االنفجارات عن األشعاع كوارث الكٌمٌائٌة Chemical الةّكاأل األحماض القلوٌة السوائل الحرارٌة Thermal النارٌة الحروق السلقٌة الحروق ًالكهربائ الصعق بالبرق الصعق الحرارة انخفاض المٌكانٌكٌة Mechanical الرضٌة اإلصابات القطعٌة اإلصابات الطعنٌة اإلصابات والوخزٌة Classification Acc. To Causative force/Agent/instrument
- 30. Medicolegal Classification Medicolegal “Forensic” Classification (Knight, 2004) 1. Abrasions سحجة / سحجات . 2. Bruises كدمة / كدمات . 3. Incised wounds جروح قطعٌة . 4. Contused wounds / Lacerations جروح رضٌة . 5. Special Types: combination of wounds in Kicking, Punching, Bite marks, strangling, firearm, explosions, …etc. Classification According To Time related to Death 1. AM. 2. PM.
- 31. Classification & Description of Wounding Dr. Mamdouh K. Zaki Doctorate of Forensic Medicine Jeddah Forensic Medicine Center MOH – Saudi Arabia Ministry Of Health Directorate of Health Affairs Jeddah Forensic Medicine Center