The wounded man (Hans von Gersdorff)
Read a Wellcome Library blog post about the history of the 'wound man' in medical texts here.
Any doctor may be asked to examine a person who has been wounded, particularly in the Emergency Unit/ Trauma Unit setting.
In addition, forensic physicians and pathologists are frequently required to examine wounds in both the living and the dead.
The identification and description of wounds may have serious medico-legal implications at a later stage - often after some considerable time has passed since the wounding.
It is therefore essential that different types of wounds can be correctly identified and described, with a full description being made in notes taken at the time of, or shortly after the examination ('contemporaneous notes').
Studies have shown that doctors incorrectly identify common wounds and injuries (Jones 2003; Reijnders et al 2005; Bajanowski et al 2001), and even where they do correctly identify a wound type, they ascribe an incorrect 'mechanism' to that wound (i.e. incorrect differentiation between blunt force and sharp force injury).
In general terms (lay and medical, but not legal), 'wound' and 'injury' are used interchangeably, and are used to describe tissue damage caused by;
- blunt force trauma (punching, kicking, beating, biting, being hit by a vehicle, falling from a height etc);
- sharp force trauma (stabbing etc);
- ballistic trauma (from firearms and blast trauma from explosives); and
- from another injurious agent, such as burns from electricity or chemicals etc.
There are several ways in which wounds can be classified. Surgeons, for example, may classify wounds into ‘clean’ and ‘dirty’ or ‘tidy’ and ‘untidy’ (Russell et al 2000).
'Tidy wounds' are those made by sharp instruments and contain no dead tissue, and which can be closed and allowed to heal by primary intention.
'Untidy wounds', however, such as those caused by crushing or tearing mechanisms often contain devitalised tissue that must be debrided (i.e. surgically removed) in order for healing to take place (after closing the wound or allowing it to heal by secondary intention).
It is essential in a medico-legal arena that the correct nomenclature is used to describe wounds, and the following sections will cover each of these wound types in detail.
Wounds can also be categorised by the manner of infliction, via the WHO International Classification of Disease (ICD) ‘E’ codes, such as ‘accidental’ or ‘suicidal’ (Saukko and Knight 2004). (See also ICD Chapter XIX codes for injury, poisoning and 'external causes'.)
wounds and injuries mindmap
The following mindmap provides an overview of the forensic classification of wounds and injuries for those who find seeing the 'big picture' useful.