Incised Wounds

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Incised wounds or cuts are produced by sharp-edged weapons or instruments. A knife is the classical example of a weapon used to inflict an incised wound, though, in fact, any instrument with a sharp edge can do so e.g., a piece of glass, metal, or paper. The sharp edge of the instrument is pressed into and drawn along the surface of the skin, producing a wound whose length is greater than its depth.

In incised wounds, the length and depth of the wound will not provide information as to the weapon. A 3-in-long incised wound could have been produced by a 6-in blade, a 2-in blade, a razor, or even a piece of glass. Incised wounds should not be confused with lacerations. Incised wounds have clean-cut straight edges free of abrasion or contusion (Figure 7.20). There is no bridging in the depth of the wound. Lacerations, which are tears in the skin caused by blunt force, generally have ragged, abraded margins with bridging

Beveled Undermined Edge Skin
Figure 7.20 Incised wound of face caused by razor. Note sharp, clean margins.

of the base. One must realize, however, that a dull, irregular-edged, or nicked cutting edge can produce an incised wound with irregular, contused, or abraded margins because the wound is caused more by the pressure applied by the weapon than by the cutting edge. No bridging in the depth of the wound will occur, however.

Wounds of the scalp produced by heavy, usually metallic, objects with sharp edges can produce lacerations with sharp, non-abraded margins that can be confused with incised wounds. Careful examination of the base of the wound usually produces evidence of bridging, thus indicating a laceration. In some instances, however, just by examining a wound alone, it will not be possible to determine if it is an incised wound or a laceration. Other wounds on the body will often suggest the etiology of the ambiguous wound.

Incised wounds often begin very superficially, deepen, and then become superficial again. If the blade is held at an oblique angle to the skin, the wound will present a beveled or undermined edge. If the angle is extreme, a skin flap will be produced. On occasion, a single slash with a sharp, edged weapon might produce more than one incised wound. These are wrinkle wounds, which occur when the skin is not flat, but "wrinkled," that is, in folds. Here, the cutting edge skips from crest to crest of the skin, leaving a string of cuts, all of which have resulted from a single slash (Figure 7.21). Usually, these lie in a straight line and it is fairly simple to deduce what has occurred. If the skin is thrown into irregular folds, an irregular zigzag wound may be produced by a single swipe of the blade. In such a case, the blade rolls up the skin before cutting through it.

Figure 7.21 Incised "wrinkle" wound caused by knife drawn across skin from crest to crest.

Figure 7.21 Incised "wrinkle" wound caused by knife drawn across skin from crest to crest.

The edges of an incised wound tend to separate or gap. The extent to which the wound gaps and the shape it subsequently assumes depend on whether it is parallel, transverse, or oblique to the direction of the elastic fibers in the skin (Langer's lines). Thus, an incised wound parallel to the contractile fibers will gap less than one made at a right angle or obliquely across the fibers because the fibers will pull the skin apart and evert the edges.

Incised wounds are usually not fatal. Most are seen in emergency rooms, where they are treated with a few sutures and the victims released. Incised wounds are most frequently inflicted on the exposed portions of the body: the head, neck, and arms. If the victim survives, the wounds usually heal by primary intention, leaving a thin, linear scar. Fatal incised wounds generally involve the arms and neck and are usually suicidal. Homicidal incised wounds almost always involve the neck.

Suicidal incised wounds are generally inflicted on those parts of the body most accessible to the victim. The victim may expose the portion of the body to be incised. For example, he may open his collar before cutting his throat, or pull up his shirt before cutting his chest or abdomen.

In self-inflicted incised wounds, one will often find hesitation marks (Figure 7.22). These are superficial incised wounds adjacent to, a continuation of, or overlying the fatal incised wound. They are very superficial and often do not go through the skin. One has the impression that the deceased attempted to cut the skin, but either because of pain or hesitancy, did not initially cut deep, but rather made multiple, very superficial cuts, almost like paper cuts, until finally, he built up enough courage to actually cut through the skin. Very superficial incised wounds identical to hesitation marks occasionally can be seen in homicidal incised wounds of the neck. This could be caused by either struggling of the individual prior to the infliction of the fatal wound or perhaps the perpetrator's initial hesitancy to cut the victim's throat.

Fatal incised wounds of the arms are almost always suicidal. As a means of attempting suicide, cutting one's wrists is a poor method. Most people have a vague knowledge of anatomy and do not know where to sever a major vessel. In addition, they usually do not cut deep enough. Some individuals cut their forearms vertically, rather than horizontally, due to an ignorance of

Suicidal Hesitation Marks
Figure 7.22 Incised wounds of neck with hesitation marks.

anatomy (Figure 7.23 A). One individual who did so had this fact explained to him by his physician. When the patient cut his wrist again later in the week, he cut the radial artery correctly and bled to death.

In self-inflicted incised wounds of the extremities, right-handed individuals usually cut the left wrist or forearm; left-handed individuals, the right wrist or forearm. These incised wounds are typically found on the flexor surface and radial aspect of the forearm (Figure 7.24 (A and B)). Thus, the presence of linear scars on the flexor surface in these areas suggests that an individual has attempted suicide in the past.

Defense wounds are wounds of the extremities incurred when an individual attempts to ward off a pointed or sharp-edged weapon. They are most commonly found on the palms of the hands, due to attempts to grasp or ward off the knife; the back (extensor surface) of the forearms and upper arms and on the ulnar aspect of the forearms (Figures 7.24 (C and D); 7.25). Rarely, defense wounds will be found on the feet or legs. In such a case, the

Incised Wound Back Forearm Pictures
Figure 7.23 (A) Three self-inflicted incised wounds of flexor surface of left forearm, the two in the wrist, vertical in orientation. (B) Detail of wound of antecubital fossa showing partial severing of artery and vein.

individual might have kicked out at the knife to try to ward it off, or he might have curled up and tried to cover his vital areas with the legs.

In self-inflicted incised wounds using double-edged razor blades, the blade will often cut the fingers of the hand holding it. If individuals are using a knife and there is a lot of blood, there is a possibility that their hands could slip from the handle onto the blade, incurring an injury. In both instances, the wounds produced simulate defense wounds.

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Responses

  • remigio
    Can you self inflict a dull knide and have it be fatal in the chest?
    8 years ago

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