INJURIES
AND
WOUNDS
PHYSICAL INJURY
In the forensic medical context, physical
INJURY refers to the damage inflicted on
“any part of the body due to the
deliberate or accidental application of
mechanical or other traumatic agent”.
A WOUND is a disruption of the continuity
of tissues and lining epithelium (layer of
the skin) produced by mechanical force.
TAKE NOTE:
The term injury is used synonymously with
wound, but the former can have a wider
meaning, which encompasses not only
damage produced by physical force, but
also damage produced by other means
such as heat, cold, chemicals, electricity,
and radiation.
TAKE NOTE:
When an attending doctor conducts a
clinical examination of a patient with
injuries and wounds and thinks that law
enforcement investigation is essential to
ascertain responsibility regarding the
case, the doctor should immediately
register it as a medico-legal case.
Cases that should be labeled as medico-
legal may include any of the following:
Roadside accidents, factory accidents or
any other unnatural mishaps
Suspected or evident homicide or suicides
( including attempted ones)
Suspected or evident poisoning
Burn injuries due to any cause
Cases that should be labeled as medico-
legal may include any of the following:
Injury cases where foul play is suspected,
i.e., if a doctor thinks that the patient is an
accused or a victim in a criminal case
Injury cases where there is a likelihood of
death in the near future
Suspected or evident sexual offenses
Suspected or evident criminal abortions
Cases that should be labeled as medico-
legal may include any of the following:
Unconsciousness, when the cause is not
clear
Cases brought dead with improper history
Cases referred by courts
BLUNT FORCE INJURIES
Blunt force injuries are those resulting from
forceful contact with a blunt object, such
as fists, hammers, baseball bats, furniture,
floors, walls, roads, trees, or the interior
surface of vehicles.
They are among the most common types
of trauma encountered by forensic
pathologists.
THREE MAIN TYPES OF BLUNT
FORCE INJURIES
ABRASION
❑They refer to superficial injuries involving only the
outer layers of the skin; they do not penetrate
the full thickness of epidermis.
❑Abrasions may bleed only slightly, heal quickly
and oftentimes, leave no scar.
TYPES OF ABRASION
BRUSH ABRASION
❑are broad patches, the frictional element of
which gave rise to the term brush burns.
❑Brush burns are commonly seen in their most
florid form as road rash following a
motor/vehicular accident in which the victim
slides along the road surface.
BRUSH ABRASION
TYPES OF ABRASION
SCRATCH
❑Is a linear abrasion produced by drawing a
sharp point over the surface of the skin or
mucous membrane.
SCRATCH
Take Note:
Abrasions are sometimes considered
superficial or trivial and are,
therefore, easily overlooked by
regular attending physicians.
However, to the forensic pathologist
or forensic physician, abrasions may
provide valuable information.
THREE MAIN TYPES OF BLUNT
FORCE INJURIES
CONTUSIONS
❑A contusion, also known as bruise.
❑It refers to a discoloration resulting from
hemorrhage beneath the skin, tissue, or mucosa,
without any associated breach in the surface.
❑The blood vessels most commonly ruptured are
the capillaries and small veins, rather than
arteries.
CONTUSIONS
Take Note:
Various terms exist to describe the
gross appearance of a contusion.
These includes petechiae,
ecchymosis, and hematoma.
PETECHIAE:
Are small punctate hemorrhages or
very small contusions. They are
minute reddish or purplish spots
containing blood that appears in the
skin and mucous membranes as a
result of localized hemorrhages. Sizes
range from pinpoint to pinhead.
PETECHIAE
ECCHYMOSES:
Are the so-called “love bites” (also
called hickeys in American slang or
chikinini in Filipino). These are
superficial contusions produced by
the negative pressure of mouth
suction.
ECCHYMOSES
HEMATOMA:
It is the extravasated blood collects
as a discreet tumor-like pool. In most
cases, the sac of blood or hematoma
eventually dissolves.
HEMATOMA
THREE MAIN TYPES OF BLUNT
FORCE INJURIES
LACERATIONS
❑It refers to the splitting of tissues and
the forceful tearing of the skin when
an object impacts the skin with a
force that exceeds its elastic
capacity.
LACERATIONS
SHARP FORCE INJURIES
Sharp force injuries refer to damage
to tissues or organs by objects or
weapons with sharp edges or pointed
ends.
They are generally classified in to
three, namely: incised, stab, and
chop wounds.
INCISED WOUNDS
Incisions or incised wounds refer to
cuts or slices caused by a sharp-
edged object that has impacted the
body in an approximately parallel or
tangential direction.
Wound tends to be straight and
longer than their depth, with no
contusion and abrasions.
INCISED WOUNDS
STAB WOUNDS
A stab wound is the result of a pointed or
sharp and pointed object force inward.
A stab wound is also sometimes called
puncture, perforating, or penetrating
wounds.
The typical feature of stab wounds is
depth greater than their width or length.
CHOP WOUNDS
Chop wounds are caused by objects
with relatively sharp edges,
possessing a reasonable weight
resulting in a combination of sharp
and blunt force injuries at the point of
impact.
DEFENSIVE WOUNDS
It refers to injuries sustained by victims
attempting to defend themselves from
attack. The wounds are often found on
the victim’s fingers, hands, forearms and
upper arms.
Defensive injuries may include not only
sharp force injuries, but also blunt force
injuries and gunshot wounds.
SELF-INFLICTED WOUNDS
Self-infliction of shallow cuts as a
form of self-harm, which falls short of
attempted suicide, are parallel,
shallowly incised wounds that heal
and leave multiple, fine, horizontal,
linear white scars.
FIREARM
INJURIES
FIREARM INJURIES
Firearm injuries refer to those caused
by projectiles fired from guns. When a
bullet or projectile has entered but
not exited the body, it is termed as
penetrating; if the projectile has
passed completely through the body,
it is termed as perforating.
GUNSHOT WOUNDS
A gunshot wound is a penetrating wound
that leaves a skin defect where the
projectile passes through the skin.
As a general rule, a gunshot exit wound
is larger and more irregular than a
gunshot entry wound due to the effect of
bullet tumbling and bullet deformation.
GUNSHOT ENTRY WOUND
A typical entrance wound has a round or
oval-shaped skin defect, surrounded by
a rim of abrasion called the abrasion
collar or circumferential marginal
abrasion.
Gunshot entry wounds vary in their
overall appearance based on the range
of fire or how far the muzzle of the
weapon is from the target.
GUNSHOT ENTRY WOUND
GUNSHOT ENTRY WOUND
Distance ranges are categorized as
contact, close contact, intermediate,
or distant.
Determining the range of fire from the
wound appearance is of forensic
importance.
CONTACT WOUNDS
Contact wounds have associated
charring of the skin, with soot
deposited within the depths of the
wound.
Some contact wounds also have
muzzle imprint abrasions.
CONTACT WOUNDS
CLOSE CONTACT WOUNDS
In close-range entrance wounds,
wherein the muzzle is close to, (but not in
contact with the skin), soot and
gunpowder will be evident around the
entrance skin defect.
Gunpowder stipple marks or gunpowder
tattooing are embedded in the skin as
gunpowder particles that strike and
injure the skin and cannot be washed
away.
CLOSE CONTACT WOUNDS
With most handguns, soot combined
with gunpowder stippling around
gunshot entrance wounds can occur
when the muzzle of the weapon is up
to about 12 inches from the skin.
CLOSE CONTACT WOUNDS
INTERMEDIATE WOUNDS
Intermediate range gunshot entrance
wounds, wherein the weapon is
greater than 12 inches but less than
about 3 feet from the skin, will have
gunpowder stippling, but no soot
surrounding the entrance defect.
INTERMEDIATE WOUNDS
DISTANT WOUNDS
Distant gunshot entrance wounds
with a range of fire over 3 feet have
no associated soot or gunpowder
stippling.
DISTANT WOUNDS
GUNSHOT EXIT WOUNDS
Exit wounds from low-velocity firearms
tend to be relatively small. The projectile
traverses the body, producing a
laceration upon exit.
Such wounds can have a variety of
shapes, such as a slit-like to comma
shaped, X-shaped, or irregularly shaped.
GUNSHOT EXIT WOUNDS
GUNSHOT EXIT WOUNDS
Sometimes low-velocity ammunitions
lack enough energy to actually exit
the body.
High velocity exit wounds tend to be
very large and destructive.
Edges of gunshot exit wound are
everted.
SHOTGUN WOUND
The lead pellets of a discharged
shotgun emerge together and
gradually diverge into a cone shape
as the distance from the weapon
increases.
SHOTGUN WOUND
When the range of fire is about 15
centimeters, entry wounds are also
usually round or oval with fairly
clean-cut margins ; the skin or
clothing having slight burning from
the flame or blackening from the
smoke and unburnt powder.
SHOTGUN WOUND
Beyond 20 – 40 centimeters, there will
be tattooing from unburnt powder,
but no blackening.
SHOTGUN WOUND
Up to about a meter, the pellets
tend to travel as a compact
mass, and thus usually cause a
circular hole.
SHOTGUN WOUND
With increasing range of fire up to
3 meters, the pellets start to
scatter and cause variable
numbers of satellite pellet holes
surrounding a larger central hole.
SHOTGUN WOUND
In over 8 to 10 meters, there
will be peppering of the skin
from individual pellets instead
of a main entry wound.
BURNS
BURNS
A burn is an injury caused by the
application of heat or by a chemical
or physical agent having an effect
similar to heat.
Most burns are produced by dry
heat and a result from contact with
flame or by a heated solid object, or
from exposure to radiant heat.
CLASSIFICATION OF BURNS
FIRST DEGREE BURN -
These injuries involve only the
epidermis and are
characterized by erythema,
edema, and pain.
CLASSIFICATION OF BURNS
SECOND DEGREE BURN –
Second degree burns are also called
partial thickness burns. The most superficial
second degree burns totally affect the
epidermis as well as the upper third of the
dermis. Such burns involve blister formation
and are extremely painful. It heals in
approximately 7 to 14 days with minimal
scarring.
CLASSIFICATION OF BURNS
SECOND DEGREE BURN – A deep
second-degree burn extends beyond the upper
third of the dermis but not beyond the dermis
itself. Ironically, these deeper burns are less
painful due to the destruction of nerve endings
in the dermis. Wound healing is extremely slow,
sometimes requiring several weeks to months.
This may lead to dense scarring, if not treated by
skin grafting.
CLASSIFICATION OF BURNS
THIRD DEGREE BURNS – Third
degree burns or full thickness burns destroy
the full thickness of the epidermis and
dermis.
There is lack of pain because all the nerve
endings are destroyed. These burns require
skin grafting because skin generation is not
possible.
CLASSIFICATION OF BURNS
FOURTH DEGREE BURNS – these
burns are also described as charring
injury due to incineration of tissues.
There is complete destruction of the skin
and subcutaneous tissues, as well as
complete or partial charring of the
bone.
TYPES OF BURNS
DRY BURNS – Dry heat sources result
in dry burns. Examples of such sources
are ovens, stove, tops, hot engines,
mufflers, radiator grills, clothes irons,
hair dryers, heating pads and furnaces.
In children, such burns may be either
accidental or inflicted. Fire-related
injuries also involve dry burning.
TYPES OF BURNS
Scalds – Scalds are produced
by moist heat or steam, or any
hot liquid, such as water, oil or
even molten rubber or metal.
They are typically less severe
than burns produced by dry
heat.
TYPES OF BURNS
CHEMICAL BURNS – are produced
through contact with corrosive acids
and alkalis. Most of these injuries
involve direct tissue damage which
cause drying and blistering, destruction
of proteins or fat or interference with
cellular metabolic processes.
TYPES OF BURNS
FIRE BURNS – Burns that occur
from building or home fires are the
most common types of thermal
injuries encountered in death
investigations. Such burns can be
caused by the radiant heat injury
alone, from the victim being on fire.
TYPES OF BURNS
RADIANT BURNS – are caused
by a heat source close to the victim
or electromagnetic energy radiating
out from an energy source. In
contrast to dry burns where direct
contact with the heat source is
required, radiant heat burns do not
require direct contact with a heat
source.
ASPHYXIA
The word asphyxia is of Greek
derivation and means “without a
pulse”.
It refers to a condition of
severely deficient supply of
oxygen to the body, which arises
from being unable to breathe
normally.
ASPHYXIA
It may be described as interference
with respiration due to any cause
like mechanical, environmental or
toxic.
When the respiratory function of
lungs stops as a result of lack of
oxygen, it causes failure of heart
and brain due to oxygen
deprivation.
CLASSIFICATION OF
ASPHYXIA
SUFFOCATION – refers to the
exclusion of air from the lungs by
means other than compression
of neck, such as through
entrapment in airtight enclosure
with inadequate oxygen in the
environment.
CLASSIFICATION OF
ASPHYXIA
SMOTHERING – is the
mechanical obstruction of the
external airways by an object
such as hand, pillow or duct
tape or plastic.
CLASSIFICATION OF
ASPHYXIA
CHOKING – involves the
obstruction of the larynx by food,
vomit blood, or other foreign bodies.
This sometimes happens when a
large bolus of food material
becomes lodged in the opening of
the pharynx or larynx, making the
victim gag and unable to inhale or
exhale.
CLASSIFICATION OF
ASPHYXIA
CHEST COMPRESSION – is
the mechanical limitation of the
expansion of the lungs by compressing
the torso, hence interfering with
breathing . Compressive asphyxia
occurs when the chest or abdomen is
compressed posteriorly, thereby
preventing cardiorespiratory function.
CLASSIFICATION OF
ASPHYXIA
STRANGULATION – is a violent
form of death that occurs when
mechanical pressure is applied to
the neck by means of a ligature or
by utilizing only the hands.
HANGING – refers to the situation
where a victim’s own body weight
causes a compressive force to be
applied to the neck.
CLASSIFICATION OF
ASPHYXIA
DROWNING – refers to a form of
death that occurs when atmospheric
air is prevented from entering the
lungs due to submersion of the body
in water or other fluids.
It is a specialized form of asphyxia
in which environmental oxygen is
displaced by a liquid.
LIGHTNING INJURIES
A lightning bolt is produced when the charged
under-surface of a thunder-cloud discharges its
electricity to the ground.
A dead body found in an open space should
raise the possibility that it was hit by a lightning
strike. When there are injuries, the clothing may
be torn or damaged and the hair may be
seared. A patterned skin burns as a result of the
metal object being hit by the lightning such as
buckle of a belt, which may be left magnetized
or even melted.
HEAD INJURIES
The effects of an injury may vary
depending on the exact area of the
body that sustained such injury.
Injuries to the head are particularly
important because of the brain’s
vital role in sustaining the life of the
individual.
HEAD INJURIES
When a person suffers from a
head injury, it may result to
loss of consciousness. These
are often associated with the
acceleration or deceleration
of the head where the brains
moves within the skull.
HEAD INJURIES
Brain injuries may be: (a)
FOCAL, which occurs just deep
to the area of head impact; or
(b) DIFFUSE, which is
consequence of the
acceleration/deceleration
forces applied linearly or
rotationally.
COUP AND CONTRA COUP
INJURIES
When an object strikes a stationary
head, it produces damage located
beneath the impact site; this is called
COUP INJURY.
When an object strikes a moving head,
there may be a coup injury on the site
of impact, but the cortical damage can
be seen on the opposite side of the
brain, which is called CONTRA COUP
INJURY.
