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Generalities
Definition- damage to the tissues of the body caused by a mechanical force Damaging agents: - Mechanical - Physical - Chemical - Biological - Psychical, psychological
Classification
I. Intact skin - Traumatic eritema - Bruise (contusion) - Hematoma
II. Injured skin - Abrasion (scratch, graze) - Wounds
Traumatic eritema
produced by a light slap or a continuous pressure against the tissues transient irritation of the nervous endingsdilatation of the vessels pain, redness of the skin/ red points on the skin, tumefaction all signs and simptoms dissapear in a few hours
Bruise/contusion
- Blunt injury to the tissue- strike or compression Blunt objects: rock, stick, club, hammer, fist, leg - Damage of the small and middle blood vessels beneath the skin- the blood leaks into the surrounding tissues - Most frequent under the skin - Possible deep bruising- any organ, tissue
Bruise/contusion
- Usually it does not reproduce the pattern of the causative object- the blood leaks in a diffuse manner Bruise changes with time and position - The bruise may become visible at a later moment from the trauma - repeated examinations - The bruise may appear at a different site than the injury site
Bruise/contusion
The speed of the changes is very variable7-10 days Recognition of bruises of different colours in the same person- inflicted at different times- repeated aggressions- child/adult abuse Differentiated from postmortem lividities
Bruise/contusion - Size
space outside the vessels for free blood to accumulate; gravity of the bleeding, depending on: * the intensity of the traumatism; * the size and the density of the vascular network in the damaged region; presence of the bone directly under the skin;
Bruise/contusion
Particular types of causation- mark bruises - Tram-line/railway-line - Bilateral ovalar bruises on the throat- manual strangulation - Envelope imprint
Tram-line/railway-line - two parallel lines of bruising with a pale undamaged area between- rod-like weapon, either cylindrical or square-sectioned
Hematoma
Definition- an important collection of blood- the rupture of a big vessel- blunt injury Localization: tissues, organs, natural cavities Superficial hematoma- the covering skin is bruised; May determine compresion of the muscles, nerves, vessels- surgical treatment to evacuate the blood; hematomas in the natural cavities or inside the organs have, frequently, a severe evolutioneven death
Abrasion
- The most superficial type of injury which destroys the integrity of the skin Mechanism: - Friction of a sharp or irregular object against the surface of the skin, determining the abrasion of the superficial layers. - Less often- vertical impact- crushed injury Two possibilities: - An object strikes the skin (a bite from a tooth) - The body hits a stationary object (fall)
Abrasion
- Usualy confined to epidermis- no bleeding - Some abrasions enter the dermis- slight bleeding (dermal papillae) Shape: - Linear - Broader- brush abrasion E.g., dragging across a rough road in traffic accidents- multiple parallel linear abrasions When the skin is protected by clothingfriction burn- reddened, excoriated area
Abrasion
Evolution the first 12- 24 hours- crust (yellow or redishbrownish); 3-4 days- the crust begins to detach; 7-8 days- a white track on the skin - dissapears without any traces
Fingernail abrasions - strangulation by hand- curved /on the neck; - linear abrasions- the finger are dragged down the skin (sexual attacks, child abuse)
Marker- abrasion
- usually when the impact is vertical to the surface of the skin (crushing abrasion);
Draging
- linear, thin, parallel abrasions - direction of the force causing the abrasion- close examination- the torn epidermis will be pulled towards the distal (final) end of the abrasion
Laceration
- Blunt injury- crushes the tissues
Laceration- characteristics
irregular edges;
Bite wound - preserve the shape of the teeth - samples of saliva- identification of the aggressor
Pricking wound
Mechanism Lateral compression of the tissues by a thin object with acute point- needle, screw driver (pricking object) Characteristics
Pricking wound
Channel in the depth of the tissues Exit wound rare the damaged part of the body is small/thin the weapon is long enough
Pricking wound
Complications severe, even lethal bleeding when blood accumulates inside a natural cavity (e.g. pericardium)
Cut wounds
- Sharply cut injuries - Produced by objects with at least one cutting edgepressure and movement of a sharp edged object against the tissues
Cut wounds
Defence wounds passive defence- cuts on the dorsal part of the hands and forearms; active defence- cuts on the palms (the victim tryes to catch the knife).
Stab wound
Mechanism: pricking and cutting the tissues, by an object with acute point and sharp edge/edges Characteristics Entry wound on the skin; characteristics of a cut wound; according to its aspect, is possible to determine if the knife has one or more cutting edges edges * buttonhole- two cutting edges * triangle- one cutting edge
Stab wound
Channel In the depth of the tissues its direction shows the weapons direction inside the tissues; Exit wound characteristics of a cut wound According to the aspect of the entry wound and channel is possible to estimate the dimensions of the knife in the cavities with a bony wall
Split wound
Mechanism: heavy objects with a sharp edge- axe, hoe, heavy sword
Appearance - combination between cut wound on the surface of the skin and laceration in depth Frequent - Bone fractures - Damages in the vital organs - danger for life
Description of injuries
Location Dimensions Shape Direction Aspect - bruise colour - abrasion crust - wound - margins - surrounding tissues - ends - content - stage of healing