Wound Classification and Types

Wounds

• Wounds are any disruption in the continuity of tissue caused by an external stimulus or force.
• Wound descriptions depend on the affected tissue; a muscle tear, for example, and a bone fracture.

Wound Classification

• Wounds are categorized in many ways, but two main classifications are:
  • Judiciary classification: Based on the estimated healing time as determined by a doctor important in legal contexts. It has 3 types:
    • Simple wounds: typically heal in less than 3 weeks with no serious consequences (such as deformity).
    • Dangerous wounds: expected to heal in more than 3 weeks, or less than 3 weeks, but with serious consequences.
    • Fatal wounds: immediately fatal or lead to death shortly after due to severe complications.
  • Classification by instrument: Abrasions, bruises (contusions), contused wounds (lacerations), cut (incised) wounds, and stab wounds are classified in this way.

Abrasions

• These affect only the epidermis and dermis.
• Medically unimportant unless infected (such as by tetanus), but legally important as evidence of violence.
  • Evidence for violence
  • Reveal the instrument used
  • Indicate the time of injury
  • Indicate site of injury
  • Differentiate cut wounds from contused wounds
  • Differentiate livor mortis from contusions

Bruises (Contusions)

• Caused by blood accumulating under the skin or in internal organs due to damage to blood vessels from blunt force trauma, like a stone or stick.
• Factors affecting bruises include:
  • Force used
  • Object used
  • Victim's physical condition
  • Tissue type
  • Victim's age

Contused Wounds (Lacerations)

• The most common type of wound.
• Characteristics:
  • Irregular margins
  • Dirty bases
  • Require significant force to cause
  • Often associated with serious trauma
  • Usually accidental or homicidal, rarely suicidal.

Cut (Incised) Wounds

• Result from putting and moving or pulling a sharp object onto the body.
• Characteristics:
  • Length greater than depth
  • Regular margins
  • Clean bases
  • Severe bleeding

Medico-Legal Importance of Wounds

• Wounds are crucial evidence of violence.
• Wounds indicate the instrument used.
• Wounds indicate the site of injury.
• Wounds reveal the amount of force used.
• Wounds reveal the nature of the object used.

Differentiating Suicide from Non-Suicide Cut Wounds

• In suicidal cut wounds, a history of problems is often present.
• Suicidal victims often leave a suicide note.
• Suicidal victims frequently have a history of attempted suicide.
• The scene of the accident is often enclosed.
• Wounds are usually found in vital locations not covered by clothing
• Wounds are typically located within the reach of the victim's arm
• The cutting hand is commonly stained with blood.
• Victim's belongings are typically found in the scene

Stab (Penetrating) Wounds

• Caused by putting and pushing a sharp object into the body.
• Characteristics:
  • Deep penetration into body
  • Depth greater than length
  • Typically smaller than the instrument used, often difficult to ascertain the instrument's size

Burns

• Burn is tissue destruction due to heat.
• Medico-legal aspects:

  • Burn type (dry heat, moist heat, chemical, physical, friction, sun)

  • Surface area of burn (measured by rule of nines or rule of hand).

  • Burn grade

    • Redness of skin
    • Blisters
    • Tissue and muscle involvement

  • Age of victim (extremes more affected)

Mechanisms of Death in Burns

• Suffocation by gases
• Carbon monoxide poisoning
• Direct tissue damage
• Inhalation pneumonia
• Septicemia
• Hypovolemia (loss of blood volume) and sympathetic shock
• Pain and parasympathetic shock
• Gastrointestinal (GI) bleeding and perforation of the duodenum.