1. Stab wounds are caused by narrow pointed objects like knives penetrating the body. They are characterized by clean margins and greater depth than length/width. 2. Stab wounds can be penetrating, entering the body cavity, or perforating, entering and exiting the body. Complications include hemorrhage, infection, and organ damage. 3. Treatment involves cleaning and debriding the wound, controlling bleeding, administering antibiotics and tetanus shots, and closing the wound. Outcomes depend on damage to tissues and treatment, but most heal well with proper care.

1. STAB WOUND
SIRTRARASAN BHARATHIDHASAN
1319

2. STAB WOUNDS
Stab wound is produced when force is delivered along the long
axis of a narrow or pointed object such as knife, dagger, chisel,
sword, sickle, etc.
Driving the object into the body, or from the body’s pressing or
falling against the object
Depth is more than the length and width.

4. Types
1. Penetrating wounds
 When the weapon enter the cavity of body or viscus.
2. Perforating wounds
When the weapon enters the body on one side and comes out from the
other side.
Known as through and through puncture wounds.
The entry wound is larger and with inverted edges.
The exit wound is smaller and with everted edges.

5. Penetrating wound Perforating wound

6. Characters
1. Margins
Edges are clean and inverted.
The margins can be everted if wound is produced on fatty area
such as abdomen and gluteal region.
Usually there is no abrasion or bruise of the margins, but in
full penetration abrasion and bruise may be found.
The margins may be abraded and ragged if the cutting edge is
blunt.

7. 2. Length
Is slightly less than the width of the weapon up to which
it has been driven in, because of stretching of the skin.
3. Width
The maximum possible width of the knife
can be approximately determined if the
gaping wounds are brought together

8. 4. Depth
It is greater than the width and length of the external injury.
The depth is usually equal to or less than the length of the blade that was
used in producing it, but on yielding surfaces like the anterior wall, the
depth of the wound may be greater , because the force of thrust may press
the tissues underneath.
The expansion and retraction of the chest is also considered.
The mobility of the internal organ is taken into account.

9. Depth of stab wound depends on
1. Condition of the knife : sharpness of tip, thin slender, double edged knife
2. Resistance offered by the organs or tissues
3. Clothing
4. Speed of the thrust of the knife
5. Stretched skin or lax skin

10. 5. Shape
It depends on –
 the type of implement, cutting surface
 sharpness, width and shape of the weapon
 body region stabbed, the depth of insertion
 the angle of withdrawal, the direction of thrust
 the movement of blade, cleavage direction
 the movement of the person stabbed, and
 condition of the tension or relaxation of the skin.

11. Slit like Wedge shaped
Elliptical shaped Fishtailing
If a single-edged weapon is used
Double-edged weapon produces

13. Reasons for the stab wound
Suicidal
They are found over accessible parts of the body.
The direction is upwards, backwards and to the right.
The depth is variable.
Homicide
Most stab wounds are homicidal , especially
found in an inaccessible area.
Accidental
Wounds are rare

14. • Marked internal hemorrhage or injuries to internal organs.
• Wound may get infected due to the foreign material carried into it.
• Air embolism may occur in a stab wound on the neck which
penetrates jugular veins. Air is sucked into the vessels due to the
negative pressure.
• Pneumothorax.
• Asphyxia due to inhalation of blood.
Complications

15. • In solid organs, the principal direction should be noted first and
other next, e.g., backwards and to the right. If the weapon is
partially withdrawn and thrust again in a new direction, two or
more punctures are seen in the soft parts with only one external
wound.
• If it is perforating, it should be described in sequential order:
• stab wound of the entrance
• path of the track, and its exit
• If it is penetrating, the wound of entrance should be described
first, then the depth and direction of wound track.
Directions

16. • The following points should be noted :
• 1) Identification and labelling of cuts and damage to clothing.
• 2) Distribution of blood stains.
• 3) Removal of clothing, layer by layer.
• 4) Identification and labelling of wounds.
• 5) Wounds:
• Position (height from heels),
• location (measurements from fixed anatomical landmarks),
• description including margins, size, shape, ends, extension,
• direction,
• depth,
• trauma to viscera,
• estimation of force required,
• foreign bodies.
Examination of the wound

17. • Initial examination (primary survey, or ABCDEs) in patients with
penetrating stab wound of thoracic and abdominal regions includes
assessment of the following:
• Airway, breathing, circulation (ABCs): Includes vital signs
• level of consciousness (D, disability): To detect neurologic deficits
• Location(s) of the wound(s) (E, exposure): Inspect all body surfaces, and
document all penetrating wounds
• Type of penetrating weapon or object
• Amount of blood loss
Before treating the wound………….

18. Debridement
• The first step in treating the stab wound is the debridement i.e. removal of
dead,damaged tissue
• Debridement removes dead, devitalized, or contaminated tissue, and any foreign
material from a wound, which helps to reduce the number of microbes, toxins, and
other substances that inhibit healing
• There are five main methods of debridement: surgical or sharp, autolytic,
enzymatic, mechanical, and biosurgical
• Surgical debridement is more preferable

19. • Surgical debridement is the fastest way to remove dead tissue.
• It causes considerable pain, and hence,usage of local anesthetics such as
ketamine ,lidocaine and enfluran applied 30 to 45 minutes prior to
debridement
•
• There may be some damage to viable tissue, and bleeding is likely
• Mild to moderate bleeding could be controlled by the application of
pressure and a hemostatic calcium alginate dressing.

20. Treatment of stab wound
For treating a Patient with stab wound a Physician must:
• Inspect the patient, and determine the extent of their injuries
• Apply a facemask and sterile gloves if possible. At the very
least, disinfect your hands.
Initial treatment consists of:
disinfection of the operative field
controlling the bleeding
treating the shock if necessary
thoroughly cleansing the wound to reduce the risk of infection

21. • Administration of local or regional anesthesia may be
necessary in order to evaluate a wound
• control bleeding (hemostasis)
• thoroughly cleanse the area by high-pressure irrigation with
saline before repair can begin.
• Any remaining foreign matter is removed, and the ragged or
unhealthy tissue is debrided under antiseptic conditions.
• Most wounds are then closed using stitches, tissue adhesive
surgical tape (steri-strips), staples, or a combination of these
methods.
• Repaired wounds are covered with an antibiotic ointment and
appropriate bandage
• A Tetanus shot (Tetanus Toxoid) should be injected to avoid
further infections

22. Prognosis and Rehabilitation
• In general, simple open wounds that are treated promptly and appropriately
have good outcomes.
• The outcome is influenced by condition of surrounding tissues and type of
treatment
• Wounds with excessive damage to blood vessel and extensive tissue loss may
lead to loss of sensation,deformity,&disability
• Specific chemotherapy restores the normal function and sensation in the
affected region
• In case of diasability physical therapy may restore the original function

23. References
• https://en.wikipedia.org/wiki/Stab_wound
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1353488/
• http://www.mdguidelines.com/open-wound
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC470915/
• https://www.reddit.com/r/askscience/comments/17k5mo/how_do_surgeons
_reattach_bones_nerves_and_blood/