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Wounds

Wounds. Definition: Classification of wounds: Anatomical Legal classification : Medico- legal classification:. Anatomical classification. Skin bone Muscle Mucous membrane Hollow organ. Legal classification:. Simple wound Dangerous wound : Fatal wound:.

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Wounds

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  1. Wounds • Definition: • Classification of wounds: • Anatomical • Legal classification: • Medico- legal classification:

  2. Anatomical classification • Skin • bone • Muscle • Mucous membrane • Hollow organ

  3. Legal classification: • Simple wound • Dangerous wound: • Fatal wound:

  4. 3-Medico- legal classification: • Sharp • Blunt • Firearm. • Physical injuries.

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

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

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

  8. 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,

  9. II- Stab wound • Definition: • 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 .

  10. Different Blades

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

  12. Hemopericardium

  13. Fabricated wound: • Definition • Characters: • Aims

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

  15. Defense wounds

  16. 2- Wounds caused by blunt instruments: • Abrasions. • Bruises (contusion). • Lacerations.

  17. 1-Abrasion • Definition • Causative instrument • Types • linear • Sliding • Pressure • Impact • Bite

  18. ML importance of abrasions • Violence • Its shape • Its site • Its age • Cut and contused wounds

  19. 2- Contusions • Definition • Types :ecchymosis –bruise-contusion -

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

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

  22. Color changes

  23. 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.

  24. 3-Contused wounds • Definition: • Characters: simulate cut wounds

  25. Deference between cut and contused W The edges Instruments Hair Bleeding Liability to sepsis Abrasion &contusion. Healing BRIDGING OF Tissues

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

  27. 1- Neurogenic or primary shock. • A- Parasympathetic inhibition of the circulation (vagal inhibition). Or • B- Sympathetico-adrinal stimulation of the circulation.

  28. 2- Traumatic shock (secondary shock). *It occurs due to: • release of histamine like substance from the severely lacerated tissues that causes • increase in the capillary permeability • and loss of capillary tone

  29. 3- Hemorrhage: (oligaemic shock): • Factors affecting the gravity of hemorrhage: a- Amount of blood lost: b- Rate of hemorrhage: c-site of hemorrhage: d- General condition of the patient: e- sex:

  30. 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:

  31. 4- Embolism 1- Air embolism: a- venous air embolism b- arterial air embolism 2- Thromboembolism: 3- Fat embolism:

  32. 5- Infection. • Contused and lacerated wounds are the most liable to severe infection particularly, • tetanus and • Gangrene • due to devitalized tissue of the wounds.

  33. 6- Crush syndrome: • Severe crushing of muscles → liberation of myoglobin→ blocking of renal tubules→ acute renal failure

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