STAB WOUND

SIRTRARASAN BHARATHIDHASAN1319

STAB WOUNDS

Stab wound is produced when force is delivered along the long axis of a narrow or pointed object such as knife, dagger, chisel, sword, sickle, etc.

Driving the object into the body, or from the body’s pressing or falling against the object

Depth is more than the length and width.

Types 1. Penetrating wounds When the weapon enter the cavity of body or viscus.

2. Perforating wounds When the weapon enters the body on one side and comes out from the

other side.Known as through and through puncture wounds.The entry wound is larger and with inverted edges.The exit wound is smaller and with everted edges.

Penetrating wound Perforating wound

Characters 1. Margins Edges are clean and inverted.The margins can be everted if wound is produced on fatty area

such as abdomen and gluteal region.Usually there is no abrasion or bruise of the margins, but in

full penetration abrasion and bruise may be found.The margins may be abraded and ragged if the cutting edge is

blunt.

2. Length Is slightly less than the width of the weapon up to which it has been driven in, because of stretching of the skin.

3. Width The maximum possible width of the knife can be approximately determined if the gaping wounds are brought together

4. DepthIt is greater than the width and length of the external injury.

The depth is usually equal to or less than the length of the blade that was used in producing it, but on yielding surfaces like the anterior wall, the depth of the wound may be greater , because the force of thrust may press the tissues underneath.

The expansion and retraction of the chest is also considered.

The mobility of the internal organ is taken into account.

Depth of stab wound depends on

1. Condition of the knife : sharpness of tip, thin slender, double edged knife2. Resistance offered by the organs or tissues3. Clothing4. Speed of the thrust of the knife 5. Stretched skin or lax skin

5. Shape It depends on – the type of implement, cutting surface sharpness, width and shape of the weapon body region stabbed, the depth of insertion the angle of withdrawal, the direction of thrust the movement of blade, cleavage direction the movement of the person stabbed, and condition of the tension or relaxation of the skin.

Slit like Wedge shaped

Elliptical shaped Fishtailing

If a single-edged weapon is used

Double-edged weapon produces

Reasons for the stab wound

SuicidalThey are found over accessible parts of the body.The direction is upwards, backwards and to the right.The depth is variable. HomicideMost stab wounds are homicidal , especially found in an inaccessible area. Accidental

Wounds are rare

• Marked internal hemorrhage or injuries to internal organs.• Wound may get infected due to the foreign material carried into it.• Air embolism may occur in a stab wound on the neck which

penetrates jugular veins. Air is sucked into the vessels due to the negative pressure.

• Pneumothorax.• Asphyxia due to inhalation of blood.

Complications

• In solid organs, the principal direction should be noted first and other next, e.g., backwards and to the right. If the weapon is partially withdrawn and thrust again in a new direction, two or more punctures are seen in the soft parts with only one external wound.

• If it is perforating, it should be described in sequential order:• stab wound of the entrance• path of the track, and its exit

• If it is penetrating, the wound of entrance should be described first, then the depth and direction of wound track.

Directions

• The following points should be noted :• 1) Identification and labelling of cuts and damage to clothing.• 2) Distribution of blood stains.• 3) Removal of clothing, layer by layer.• 4) Identification and labelling of wounds.• 5) Wounds:

• Position (height from heels),• location (measurements from fixed anatomical landmarks),• description including margins, size, shape, ends, extension,• direction,• depth,• trauma to viscera,• estimation of force required,• foreign bodies.

Examination of the wound

• Initial examination (primary survey, or ABCDEs) in patients with penetrating stab wound of thoracic and abdominal regions includes assessment of the following:

• Airway, breathing, circulation (ABCs): Includes vital signs• level of consciousness (D, disability): To detect neurologic deficits• Location(s) of the wound(s) (E, exposure): Inspect all body surfaces, and

document all penetrating wounds• Type of penetrating weapon or object• Amount of blood loss

Before treating the wound………….

Debridement

• The first step in treating the stab wound is the debridement i.e. removal of dead,damaged tissue

• Debridement removes dead, devitalized, or contaminated tissue, and any foreign material from a wound, which helps to reduce the number of microbes, toxins, and other substances that inhibit healing

• There are five main methods of debridement: surgical or sharp, autolytic, enzymatic, mechanical, and biosurgical

• Surgical debridement is more preferable

• Surgical debridement is the fastest way to remove dead tissue.

•  It causes considerable pain, and hence,usage of local anesthetics such as ketamine ,lidocaine and enfluran  applied 30 to 45 minutes prior to debridement

• •  There may be some damage to viable tissue, and bleeding is likely

•  Mild to moderate bleeding could be controlled by the application of pressure and a hemostatic calcium alginate dressing.

Treatment of stab wound

For treating a Patient with stab wound a Physician must:• Inspect the patient, and determine the extent of their injuries• Apply a facemask and sterile gloves if possible. At the very least,

disinfect your hands.Initial treatment consists of: disinfection of the operative field controlling the bleeding treating the shock if necessary thoroughly cleansing the wound to reduce the risk of infection

•  Administration of local or regional anesthesia may be necessary in order to evaluate a wound

• control bleeding (hemostasis)• thoroughly cleanse the area by high-pressure irrigation with

saline before repair can begin.•  Any remaining foreign matter is removed, and the ragged or

unhealthy tissue is debrided under antiseptic conditions.• Most wounds are then closed using stitches, tissue adhesive

surgical tape (steri-strips), staples, or a combination of these methods.

• Repaired wounds are covered with an antibiotic ointment and appropriate bandage

• A Tetanus shot (Tetanus Toxoid) should be injected to avoid further infections

Prognosis and Rehabilitation

• In general, simple open wounds that are treated promptly and appropriately have good outcomes.

• The outcome is influenced by condition of surrounding tissues and type of treatment

• Wounds with excessive damage to blood vessel and extensive tissue loss may lead to loss of sensation,deformity,&disability

• Specific chemotherapy restores the normal function and sensation in the affected region

• In case of diasability physical therapy may restore the original function

References

• https://en.wikipedia.org/wiki/Stab_wound• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1353488/• http://www.mdguidelines.com/open-wound• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC470915/• https://www.reddit.com/r/askscience/comments/17k5mo/how_do_surgeons

_reattach_bones_nerves_and_blood/