BRUISES;LACERATIONS

BY FAIZA MATEENROLL NO. 36

OUTLINE

BRUISES Definition Classification Characteristics Factors modifying Colour changes in a bruise Age of a bruise Medicolegal significance LACERATIONS Definition Classification Characteristics Medicolegal factors

BRUISES Vs LACERATIONS                

BRUISES(CONTUSIONS)

BRUISES(CONTUSIONS)DEFINITION;- “A bruise signifies haemorrhage into the

skin, the subcutaneous tissues, or deeper tissues.It is due to an infiltration or extravasation of blood into the tissues, following rupture of small vessels, as a result of blunt force.”

BRUISES(CONTUSIONS)CLASSIFICATION;- 1.Intradermal Bruise 2.Subcutaneous Bruise 3.Deep Bruise

BRUISES(CONTUSIONS)INTRADERMAL BRUISE:- When a bruise is made by impact

with a patterned object, the haemmorhage may lie in the immediate subepidermal layer & its pattern may correspond to the form of the object or the weapon causing it, e.g, whips, canes, bicycle chain etc.

INTRADERMAL BRUISE

BRUISES(CONTUSIONS)SUBCUTANEOUS BRUISE:- The usual bruise from a blunt impact is

situated in subcutaneous tissues. It is somewhat blurred at the edges & raised above the skin surface due to infiltration of blood in subcutaneous tissues.

SUCUTANEOUS BRUISE

BRUISES(CONTUSIONS)

• DEEP BRUISE:- This signifies bleeding deeper to the

subcutaneous tissues & some swelling may be apparent when the opposite limb or part of the body is compared with the injured area. It may take hours or one or two days to appear at the surface.

DEEP BRUISE

BRUISES(CONTUSIONS)• CHARACTERISTICS:-1. May not always be present at the site of impact.2. The greater the force or violence used, the more

extensive is the bruise.3. Spreads due to continued extravasation &

consequently occupies a wider area, it is not possible to assess the area of impact & severity of violence in such cases.

BRUISES(CONTUSIONS)• FACTORS MODIFYING APPEARANCE OF A BRUISE:-1. Site of injury2. Vascularity of the part3. Age4. Sex5. Colour of skin6. Natural disease7. Gravitational shifting of blood

BRUISES(CONTUSIONS)• COLOUR CHANGES & AGE OF A BRUISE:- After a bruise has appeared, it tends to get smaller from

periphery to center & passes through a series of colour changes:-

1. Red Immediately after infliction2. Dusky purple/ Black Fairly fresh(1/2-8hrs)3. Blue 8hrs-4days to 2 weeks4. Green 4days-1 or 3 weeks5. Yellow 7days to 3 weeks6. Disappears 1-4weeks

BRUISES(CONTUSIONS)

• MEDICOLEGAL SIGNIFICANCE:- Bruises provide information in regard to:-1. Identification of the object causing the injury.2. Degree of violence.3. Cause of injury.4. Time of injury.5. Possibility of infection.

LACERATIONS

LACERATIONS

DEFINITION:- “ A laceration is a wound in which the

skin, mucosa or underlaying tissues are torn as a result of application of blunt force”

LACERATIONS

CLASSIFICATION:-1. Split laceration2. Stretch lacerations3. Avulsion4. Tears5. Internal laceration

LACERATIONS

1. SPLIT LACERATIONS:- The injury is due to crushing of the

skin between two hard objects, viz, underlaying bone & the object responsible for injury.The result is linear split in the skin & injury may simulate an incised wound.They are commnly found in parts overlaying bones without much tissue in between i.e on scalp, face, hands & lower legs.

SPLIT LACERATION

LACERATIONS

2. STRETCH LACERATIONS:- This is due to over-stretching of the

skin till it splits & produces a flap.Such an injury is produced by a blunt tangential impact, e.g, laceration of the scalp when the head strikes a motor car wind screen.It is also produced when sudden deformaity of a bone occurs after a fracture.

STRETCH LACERATION

LACERATIONS

3. AVULSION:- This is due to grinding compression of

tissues to such an extend as to separate the skin from deeper structurs(degloving of skin) & crush the muscles underneath.It results from horizontal crushing impact such as by lorry wheel or by machinery.

AVULSION

LACERATIONS

4. TEARS:- The injury results from irregular tearing of

skin & tissues. These are due to impact against irregular or sharp objects, e.g motor car door handles, blows from broken bottles.

TEARS

LACERATIONS

5. INTERNAL LACERATIONS:- When the blunt force exceeds the tensile

strength & elasticity of an internal organ or tissue, laceration may result in such organ without any surface tear.

INTERNAL LACERATION

LACERATIONS

• CHARACTARISTICS:-1. The edges are ragged, irregular, & bruised.2. The margins are abraded.3. Hair follicles & blood vessles are seen to have

been crushed.4. External haemorrhage not pronounced.5. Foreign material found in the wound.6. Surface appears depressed.

LACERATIONSMEDICOLEGAL FACTORS:- In examination of a victim the following essentials

should be kept in mind:-1. External evidence of Injury may be minimal or absent

even massive internal injuries may be present.2. Tissues will bleed less.3. Foreign material or trace evidence indicate agent

responsible.4. Pattern of injury.5. Suicidal lacerations.6. Homocidal lacerations.7. Accidental lacerations.

BRUISES Vs LACERATIONS

BRUISES Vs LACERATIONS

BRUISES LACERATIONS

Skin, mucosa, or underlaying tissues remain intact.

Haemorrhage into skin, subcutaneous tissues, or deeper tissues.

Closed woundMay not always be present at

the site of impact.Foregin bodies not present.

Skin, mucosa, or underlaying tissues are torn.

Haemorrhage not pronounced.

Open woundAlways present at the site of

impact.

Foregin bodies frequently present.