Wounds l Definition l Classification of wounds Anatomical

Wounds l Definition: l Classification of wounds: Anatomical Legal classification: Medico- legal classification: 1. 2. 3.

Anatomical classification l Skin l bone Fatal wound: l Muscle l Mucous membrane l Hollow organ

Legal classification: l Simple wound l Dangerous wound: l Fatal wound:

3 -Medico- legal classification: l Sharp l Blunt l Firearm. l Physical injuries.

A-Wounds caused by sharp instruments Incised (Cut) wounds. Stab penetrating wounds. NB Transfixing wounds. Defense wounds n n n

I-Incised (cut) wound: Definition : n Characters: n 1 - The edges 2 - The length 3 - Gaping of the edges 4 - Bleeding 5 - Liability to sepsis 6 - Healing

Its age can be determined to know the time of its infliction by histological examination 30 minutes – 4 hours: n Margination of polymorph nuclear leucocytes 48 hours: n Pus may be present if sepsis occurs. 10 -15 days: n Complete healing by primary intention if no sepsis.

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, n n n

II- Stab wound Definition: n 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. n n n n

Different Blades

Types of stab wounds: Ordinary stab wounds. Punctured wounds. Penetrating wounds (3 PMS). Transfixing wounds. n n

Hemopericardium

Fabricated wound: Definition n Characters: n Aims n

Defense wounds Definition: 1 - Injuries sustained by grasping the weapon: 2 - Injuries sustained during raising the hand

Defense wounds

2 - Wounds caused by blunt instruments: Abrasions. n Bruises (contusion). n Lacerations. n

1 -Abrasion Definition Causative instrument Types linear Sliding Pressure Impact Bite n n n. 1. 2. 3. 4. 5

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ML importance of abrasions Violence Its shape Its site Its age Cut and contused wounds . 1. 2. 3. 4. 5

2 - Contusions Definition n Types : ecchymosis –bruise-contusion - n

Factor affecting size of contusion Age Sex Color of the skin. Gravity. Blood Diseases Force Onset of death: ML importance n n n n

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

Color changes

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. n n

3 -Contused wounds Definition: n Characters: simulate cut wounds n

Deference between cut and contused W 1. 2. 3. 4. 5. 6. 7. 8. The edges Instruments Hair Bleeding Liability to sepsis Abrasion &contusion. Healing BRIDGING OF Tissues

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

1 - Neurogenic or primary shock. A- Parasympathetic inhibition of the circulation (vagal inhibition). Or B- Sympathetico-adrinal stimulation of the circulation. n n

2 - Traumatic shock (secondary shock). *It occurs due to: release of histamine like substance from n the severely lacerated tissues that causes increase in the capillary permeability n and loss of capillary tone n

3 - Hemorrhage: (oligaemic shock): Factors affecting the gravity of n hemorrhage: a- Amount of blood lost: b- Rate of hemorrhage: c-site of hemorrhage: d- General condition of the patient: e- sex:

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:

4 - Embolism 1 - Air embolism: a- venous air embolism b- arterial air embolism 2 - Thromboembolism: 3 - Fat embolism:

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

6 - Crush syndrome: Severe crushing of muscles → liberation of myoglobin→ blocking of renal tubules→ acute renal failure n

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