Essay: Identifying antemortem/postmortem nature of wounds

INTRODUCTION
A wound can be elaborate as the sudden discontinuation of the connection of bodily tissues due to some external force or action by some substance either blunt or sharp. The definition also contains burns from fire or heat, electricity, all type of laceration and bruises and the effects of any type of force upon the body. Under sec 44 of IPC the term injury mentioned like any harm whatever illegally caused to any person, on body, mind, reputation or property. It will include any tortuous act also.
The characteristics of an injury caused by external force:

• The nature and shape of the weapon.
• The amount of energy in the weapon or instrument when it strikes the body.
• Whether inflicted on a moving or a fixed body.
• The nature of the tissues involved.
• The area over which the force acts.

The main features to identify the antemortem/postmortem nature of wounds are:

• Haemorrhage
• Retraction of the edges of the wounds
• Sign of inflammation

1.HAEMORRHAGE
when the victim dies immediately from a fatal injury and shock. The effused blood is forced into the tissues in the vicinity of the wound and is found infiltrated into the cellular and muscular tissues. Consequently, staining of the edges of the wound and the neighbouring tissues occurs. In a wound inflicted after death, even when the body is still warm, these features are far less pronounced. It would be fair to say that the quantity of blood lost may assist in determining the antemortem or post-mortem origin of wound.
2.Retraction of wounds edges
During life, healthy skin is slightly on the ‘stretch’ and so are the muscles in a condition of ‘tone’. This causes the wounds to gape. But this elasticity does not cease at the moment of death and muscles also retain tone for sometime after death; therefore, the skin wounds inflicted before or shortly after death will retract, though the degree of gaping may vary and be appreciated by an experienced doctor.
3.Signs of inflammation or of repair
There are signs of vital reaction and will depend upon the period of survivability of an individual after infliction of wound. If the vicinity of the wound shows swelling, extravasation of lymph, blood or adhesion of edges, etc., it not only indicates that the wound was inflicted during life but also may give some indication as to the time of its infliction. If wound has become infected, pus may be seen after a period of about 36 hours. Once infection has supervened, healing may be delayed and it is often impossible to determine the age of the wound with any degree of accuracy.
WOUNDS HEALING
HEALING BY FIRST INTENTION (PRIMARY UNION)
In the process of inflammation, the healing is started. This process contains three major points i.e

• Alteration – it happens in vascular calibre which leads to the increasing of blood pressure. structural changes in the microvasculature that permit plasma proteins to leave the circulation emigration of the leucocytes from the microcirculation and their accumulation in the focus of injury. These components for the earliest ‘Triple Response’ following the injury, i.e. heat, redness and swelling.

HEALING BY SECOND INTENTION ( SECONDARY UNION)
The repair process is more complicated because cells or tissue loss is more in inflammatory ulcerations, abscess formation or in large wounds. In these types of condition, the recreation of parenchymal cells alone cannot restore the original shape and size. Because of this there is a huge rate of ingrowth of granulation tissues from the wounds, followed in time by formation of extra collagen material. This form of healing is known as the secondary union or healing by second intention
Secondary healing differs from primary healing in several respects:

• Large tissue defects intrinsically have a greater volume of necrotic debris, exudate, and fibrin that must be removed. Consequently, the inflammatory reaction is more intense with greater potential for secondary inflammation mediated injury.
• Much larger amounts of granulation tissue are formed. Larger defects accrue a greater volume of granulation tissue to fill in the gaps in the stromal architecture and provide the underlying framework for regrowth of tissue epithelium. A greater volume of granulation tissue generally results in a greater mass of scar tissue.

Stages of Healing
i) Stage of Haematoma Formation
Haematoma gets formed between and around the fracture surfaces, and a ring of bone immediately adjacent to the fractured ends becomes ischaemic over a variable length.
ii) Stage of Subperiosteal and Endosteal Proliferation
Proliferation of cells occurs from deep surface of periosteum. These cells are the precursors of osteoblasts and surround each fragment of the fracture. Similarly, cells from endosteum and the bone marrow also proliferate and try to bridge the gap.
iii) Stage of Callus (Woven Bone) Formation
Osteoblasts lay down intercellular matrix of collagen and polysaccharide, which becomes impregnated with calcium salts to form immature bone. This is termed as ‘woven bone’.This mass of callus or woven bone is visible in radiography and imparts the earliest radiological indication of a uniting fracture.
iv) Stage of Consolidation
The woven bone that forms the primary callus (soft callus) is gradually transformed by the activity of osteoblasts into more mature bone (hard callus).
v) Stage of Remodelling
Newly formed bone often forms a bulbous collar surrounding the bone and obliterates the medullary canal. The size of this bulbous mass varies depending upon factors like extent of haematoma and displacement of fragments. The bone is gradually strengthened along the lines of stress at the expense of surplus bone outside the lines of stress.
INJURIES BY BLUNT FORCES
The skin manifestations of blunt trauma differ depending upon the force and nature of the impact. Three basic lesions are recognised:

• Abrasions
• Contusions
• Lacerations.

ABRASION
Abrasions are those kinds of injuries which are made on the mucous membrane or epidermis due to the collision on some blunt weapon or object. The actual abrasion does not really bleed, because of the protecting nature of the dermal papillae. The larger abrasion may be cause bleeding. If the blood vessels are involved then the serious bleeding is possible.
TYPES OF ABRASIONS

• Scratches or linear abrasion – these types of abrasion can produce by the horizontal or tangential scraping with the shape object like nail, needle etc. on the epidermis layer.
• Grazes – these types of abrasions are formed by the horizontal or tangential scraping with the broader shape object. The epidermis will get heaped up at the opposite end and the pattern of heaping will indicate the direction of movement of the object/weapon against the skin. They may frequently be associated with underlying bruising. These types of abrasions caused by violent lateral (tangential) rubbing against a rough surface are called brush burns.
• Pressure Abrasions – In these kinds of abrasion, the force of the object is vertically and because of this the skin get crushed and abrasion is formed with the imprint of the impacting object.

ANTEMORTEM/POSTMORTEM ABRASIONS
if the person is alive, the detection of abrasions does not so problematic. But in the dead ast the blood circulation stops, there is no secretion of serum and because of that the surface gets dried up and becomes hard and brownish in colour.the dried abrasion looks more extensive then it was at the time of death.
Postmortem abrasions may be caused during transportation of the dead body. These abrasions may also leave hard yellow areas that can be differentiated if examined with care. Abrasions sustained at or about the time of death cannot be distinguished with certainty. If, however, any associated bruising or vital reaction can be shown either by naked eye or by microscopy, then differentiation can be established. The presence of fair amount of bleeding, of course, favours antemortem production.
MEDICOLEGAL CONSIDERATIONS

• Their importance lies in the fact that they are produced at the point of impact of the blunt force, e.g. abraded knuckles or knees may show the involvement of these areas.
• They may exhibit a pattern thereby providing information regarding the nature of force. There seems to be no need to list all the possible patterns that can be distinguished on the body and a few having a particular medicolegal significance have already been described under ‘patterned abrasions’.
• Presence of some material like mud, grit, coal dust, cement, sand, lime dust, pebbles or any vegetation, etc. in and around the abraded area will suggest the nature of the surface or agent responsible for its causation. Various stages of healing of an abrasion are helpful in determining the approximate period of infliction of the injury.

It is a well-known postmortem phenomenon that abrasions and bruises become more prominent after sometime following death. The appearance of body after a lapse of 24 hours or so following death may be quite different from the appearance immediately succeeding death. In a body recovered from water, abrasions may be appreciated sometimes after its recovery when they manifest more prominently on drying.
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