1. LECURER , FORENSIC MEDICINE,MCST
Wounds
Medicolegal view
Dr. Aly Samy Somaa
MB.ChB,Msc,ABFMD,MD
LECURER , FORENSIC MEDICINE,MCST
Dr. Aly Samy 2013
Dr. Aly Samy ,PSMCHS

2. Objectives: To know the following
definition and classification of wounds
the type of trauma and wounds of medico-legal importance
factors affecting the wound
estimate the date of wound occurrence
different types of wounds
complications of wounds
Dr. Aly Samy 2013

3. Definition of Wound
Disruption of the continuity of tissues produced by external mechanical force
Dr. Aly Samy 2013

4. Origin of word: Injury From Latin: “injuria” (in- not, jus- the law)
The term is often used synonymously with wound but can have a wider use, including damage to tissues by
Heat
Cold
Chemicals
Electricity
Radiation
Mechanical force
Dr. Aly Samy 2013

5. Classification of wounds
Legal classification:
A- simple wound جـرح بسيط:
which heals rapidly in less than 20 days leaving no deformity and no permanent infirmity.
B- Dangerous wound جـرح خطير
Dr. Aly Samy 2013

6. Classification of wounds- cont
which heals in more than 20 days and/or leaving a permanent infirmity.
C- Fatal or mortal wound جـرح مميت :
which cause death immediately or later due to complications
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7. Medicolegal classification
Abrasions
Contusions
Cut wounds
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8. Medicolegal classification-cont
Contused wounds
Stab wounds
Firearm wounds
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9. 1-Abrasions
Destruction of the superficial layers of the skin following contact with rough object. Bleeding is minimum, it heals rapidly in few days. Abrasions are usually localized at the site of trauma
Dr. Aly Samy 2013

10. 1-Abrasions Blunt force applied perpendicular to the body surface
Scrape.
dragging: Dragging of the body as in street accidents, broad and multiple and may take the shape of the causative instrument.
Sliding: sliding semi sharp object as finger nails leading to parallel lines
Impact abrasion
Blunt force applied perpendicular to the
body surface
Overlying bony prominence
pattern/imprint abrasion
finger nail
ligature or rope abrasion
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11. Medicolegal importance of abrasion
It may be the only evidence of a crime
1. Type of the crime from its site. e.g.
smothering. Abrasions around mouth
throttling .Abrasions around neck
strangulation
Hanging or
rape.
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12. Medicolegal importance of abrasion- cont
2. The instrument used:
Finger nail
Bite
Rope
dragging
3,Direction of the injury and position of the assailant
4. Identify the assailant
5.Differentiate incised and contused wounds.
Dr. Aly Samy 2013

13. The age of abrasion
The age of abrasion gives an idea about the date of the crime:
1st day: It is reddish, tender, oozing serosanguinous .
2nd day: soft yellow scab
3rd day, it is covered with brown red soft
scab. Gradually the scab dries up and
4TH DAY become dark brown.
7-10 days : Fallen of the dry scab occurred
from leaving a red colored area.
Disappearance of the abrasion occurred in three weeks
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14. DIFRENCES BETWEEN AM &PM ABRASIONS
AM ABRASIONS
PM ABRASIONS
A-Reddish, swollen.
ABSENT
B-May be accompanied by bruises
C. On microscopic exam.  Vital tissue reaction
D. Some remnants of the damaged epithelium.
E. Occur anywhere
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15. 2-Contusions or burises
1. Definition:-
Extravasations of blood in
the tissues following rupture of
blood vessels as a result of
application of blunt force.
It varies in size from a small
pin head ecchymosis to a large
collection of blood, known as
hematoma
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16. first bright red (oxy HB)  violet, then  bluish (reduced HB)
The color of a bruise
first bright red (oxy HB) 
violet, then 
bluish (reduced HB)
green (biliverdin) 
yellow (bilirubin)
It gradually disappears in 15 days
(range from 2-4 weeks).
The color changes occur from the periphery inwards
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17. Danger of the bruises 1. Neurogenic shock.
2. Injury to internal organs and hematoma.
3. Liability to sepsis and death from septicemia.

18. Medicolegal importance of the bruises
1. evidence of crime or violence.
2. evidence of signs of resistance.
3. The date of the crime can be
estimated from its age.
4. instrument used (from its shape).
5. Differentiate between incised and
contused wound.
6. May be the cause of death.
7. It should be differentiated from hypostasis
8. Site : usually at the same site or may be shift as black eyes
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19. DIFRENCES BETWEEN AM &PM BRUISES
AM BRUISES
PM BRUISES
SWELLING NO
CHANGE OF COLOR
CELLULAR REACTION
BLOOD CLOTING

20. DIFFERENCE BETWEEN HYPOSTASIS AND BRUISES
BRRUSIES
HYPOSTASIS
SWELLING AT AGES NO
ANY SITE OF THE BODY
DEPENDENT AREA
NO BLANCHED BY PRESSURE
YES
CUTTING OVER SHOWS BLOOD CLOT
COULDN’T BE WASHED OUT
Accompanied by abrasions

21. Hypostasis: 1. A postmortem change. 2. Site: dependent parts.
3. Intact Skin.
4. No swelling, no color changes and no marked edges.
5. By pressure the color disappear.
6.The blood is intravascular, and fluidly.
7. No cellular infiltration

22. 3. contused wound 3- Contused wound Definition:
An open injury produced by the impact of blunt force against the body.
It is caused by a stick, stone, or fall from a height.
The edges are usually abraded with contusions around, and the angles may be multiple and irregular.
Dr. Aly Samy 2013

23. 4-Lacerated wound Definition
It is a contused wound where the edges are severely damaged and highly irregular, with multiple angles.
Dr. Aly Samy 2013

24. Medicolegal importance of contused wound
1.It indicates the type of injury and causal instrument.
2.Could simulate incised
wound in the skin
stretched over bone
e.g. scalp.
3.If in the head it may
accompanied by fracture.

25. Danger of Contused wound
1.Liability to sepsis.
2.Neurogenic shock.
3.Crush syndrome. Myoglobinuria  Renal failure.
4.Fat embolism (fracture of long bones).
5.On healing a scar is produced  may leave permanent infirmity.

26. 5-Incised wound (cut wound)
Definition:
It is produced by drawing the sharp edge of a sharp instrument along the surface of the skin with sufficient pressure e.g. of sharp instrument, knife, razor, and broken glass.
Manner of incised wound
suicidal
homicidal
accidental
defense
Hesitation
Therapeutic

27. 6-Incised wound (cut wound)

28. Danger of incised wound
1. Severe bleeding.
2. Cutting of important nerves and tendons.
3. Air embolism.
4. Infection

29. Medicolegal importance of incised wound
1. It indicates the type of instrument used.
2. Its site indicates the type of crime whether homicidal or suicidal.
3. Could simulate contused wound.

30. Antemortem or post mortem cut wound
Edge gap widely
No gapping hg
No hg
Blood clot at the base
No blood clot
Swollen edges
No swelling
Evidence of sepsis of healing
Cellular reaction no

31. 6- Stab wound Definition:-
A wound caused by thrusting or forcing sharp pointed instrument into the body, having a sharp edged blade e.g. knife, scissors.
Dr. Aly Samy 2013

32. Wounds similar to stab Punctured Wound:
Caused by thrusting an instrument
with a blunt edge and pointed end e.g. nail.
Dr. Aly Samy 2013

33. Wounds similar to stab Penetrating Wound:
These are stab or punctured wounds
reaching a body cavity eg: chest (pleura, pericardium), abdomen (peritoneum), joint cavity.
Transfixing Wound = Perforating Wound:
These are stab or punctured wounds transfixing a limb or even the whole body.
Dr. Aly Samy 2013

34. Characters of stab wound
1. More deep than long.
2. The edges :
are cleanly cut without surrounding abrasions or contusions.
3. The shape:
- Bibladed knife(double dladed)  Two pointed sharp angle.
- Monobladed knife(single bladed)  One end is sharp pointed, the other is transverse
Dr. Aly Samy 2013

35. Danger of stab wound 1. Neurogenic shock. 2. Injury to vital organs.
3. Internal hemorrhage.
4. Sepsis.
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36. DEFENSE WOUNDS = SELF PROTECTION WOUNDS
These results from the victim's spontaneous reaction of self protection when he is attacked.
He may either grasp the weapon to prevent it injuring a vital part, or may raise his arm or hand to ward off an attack.

37. DEFENSE WOUNDS = SELF PROTECTION WOUNDS

38. Fabricated wound
They are usually done by the person himself (self inflicted wounds) to give suspicious of self defense or by the aid of another person in agreement with him.
They are usually superficial,
consists of a series of parallel
or crossing incisions.

39. Fabricated wound
Commonly seen over accessible parts e.g. top of the head, forehead, neck, front of chest or abdomen.
Usually there is no corresponding cuts on the clothes.

40. Causes of death from wound
I. TRAUMATIC SHOCK
A. Primary or neurogenic shock:
i. Death from reflex vagal inhibition of the heart i.e. parasympathetic stimulation  slowing of the heart  instantaneous death.
ii. Death from sympathetic stimulation of the cardiovascular system .
B-Secondary or hemorrhagic shock

41. Causes of death from wound cont
II. HEMORRHAGE:
Types of hemorrhage:
1. Primary hemorrhage follow immediately after injury.
2. Reactionary hemorrhage is usually delayed for several hours up to 24 hours after injury.
3. Secondary hemorrhage is due to infection of a wound, it occurs between days after injury

42. Causes of death from wound
III. INFECTION OF THE WOUND.
IV. EMBOLISM:
A. Air embolism
The minimum amount of air to cause air embolism is 60 ml.
B. Pulmonary embolism due to deep vein thrombosis.
C. Fat embolism.

43. CASES- I. A PHOTO showing: ORGAN:----------- Causative instruments 
against a rough
surface AS
Victim died soon after the injury
(absence of any evidence of healing
or sepsis)
Dr. Aly Samy 2013

44. CASES- II. A PHOTO showing: -------------------- Causative instruments
their colour points to there A, M. nature absence of any evidence of healing or sepsis indicates that death
happened soon after the injury.
 Cause of death:
Neurogenic shock.
Dr. Aly Samy 2013

45. CASES- III. A PHOTO showing: the anterior ----------chest wall
showing lesion:
SIZE .5X1.5 cm
Site: about
Elliptical in shape i.e.
caused by single
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46. CASES- III. A.M. wound (presence of hg.)
Death occurred soon after the injury (absence of any evidence of healing or sepsis of surgical interference.
Causes of Death:
Haemorrhage
Dr. Aly Samy 2013

47. IV A PHOTO showing: --------------------------
wound
instrument.
DESCRIPTION  
Possible cause (s) of death:
Brain laceration
Interacranial Haemorrhage.
Dr. Aly Samy 2013

48. Dr. Aly Samy 2013