Common mistakes doctors make: incised wounds vs lacerations and bruises vs abrasions...

#medicalerrors #incisedwounds #lacerations #abrasions

One of the most common mistakes I see when examining medical records for patients, for whom I have been instructed to provide medical reports, is the terminology used to describe the injuries they have sustained, especially seeing the terms "incised wounds" and "lacerations" used interchangeably. I most often see this in operation notes or Accident and Emergency records and it is problematic, not only from a medicolegal perspective, but also because it shows a lack of understanding of the underlying mechanism that causes each type of injury.

The easiest way to remember the different wound types is to differentiate them according to whether they were caused by blunt or sharp force trauma.

Blunt force trauma (i.e. from contact with a dull, firm object)

Superficial, tangential forces that don't breach the dermis cause abrasions (scratches)

Stronger forces cause bruises (also described as ecchymoses or contusions): extravasation of blood into the surrounding tissues, visible to the naked eye as an area of discolouration.

Even stronger forces cause lacerations: Bursting, tearing or splitting of the skin caused by shearing or crushing blunt forces, often with tissue bridges (persistent strands of tissue, eg nerves and vessels)

Even stronger blunt forces cause avulsions (or degloving injuries): the skin or soft tissue is torn away from it attachements.

Sharp force trauma (i.e. from objects with sharp edges or pointed objects)

Sharp force trauma typically causes incised wounds (longer than they are deep) or puncture (stab) wounds (deeper than they are long).

Some injuries are caused by a combination of blunt and sharp force (eg chop wounds) and are thus difficult to categorise. Furthermore, each type of injury may show different characteristics according to the specific causative mechanism. These are outwith the scope of this post.