Blunt Force Injuries of the Extremities

These injuries may be limited to the skin and subcutaneous tissues or extend to muscles, blood vessels, nerves, bones, and joints. Injuries to bone are described in Chapter 4.

Avulsive wounds of the lower extremities are most frequently seen in automobile-pedestrian accidents. If an automobile wheel passes over the lower extremities, it can exert tangential pressure on the skin and subcutaneous tissues, separating them from the underlying muscles. The pocket created is soon filled with blood and liquefied fat. In other instances, the skin and subcutaneous tissue are also torn, forming a large flap of skin (Figure 5.7). A blood-filled pocket may also be produced in the back and/or lateral (outer) aspect of the thigh in pedestrians impacted by the front of the hood. The tangential force of the hood impacting the thigh strips the skin and subcutaneous tissue from the muscle, creating a blood-filled pocket (Figure 5.8).

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