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Ofallregionalinjuries,thoseoftheheadandneckarethemostcommonandmost

importantinforensicpractice.Adelson(1974)givesthesesoundreasonsforthis
dominanceofheadinjuries:

Theheadisthetargetofchoiceinthegreatmajorityofassaultsinvolvingblunt
trauma.

Whenthevictimispushedorknockedtotheground,heoftenstrikeshishead.

Thebrainanditscoveringsarevulnerabletodegreesofblunttraumathatwould
rarelybelethalifappliedtootherareas.Asoundpracticalunderstandingofthe
neuropathologyoftraumaismoreessentialtotheforensicpathologistthanany
otheraspectofhissubject,asheadinjuriesprovidethemajorcontributiontodeath
inassaults,fallsandtransportationaccidents.

hescalpisoften,thoughbynomeansinvariably,damagedintraumathatcauses
injurytotheunderlyingskull
andbrain.Theusualrangeofabrasions,contusionsandlacerationsmaybe
inflicted,thoughamodifyingfactoristhepresenceofhair,whichmaydeflecta
tangentialbloworpartlycushionadirectimpact.
Whenaninjuryisvisibleontheforehead,thebackoftheneck,thelowertemple
oronabaldarea,theexaminationisnodifferentfromelsewhereonthebody.In
haircoveredareas,caremustalwaysbetakenatautopsytopalpatethescalpin
anycaseinwhichthereisapossibilityofinjury,otherwiseabrasions,swelling,
bruisingandevenlacerationsmaybemissed.Whenalesionisfoundorsus
pected,thehairmustbecarefullyshavedawaytoexposethescalpforfurther
examinationandphotography.

Forensicanatomyofthescalp
Superficially,theskincarrieshairfollicles,sebaceousglandsandsweatglands.
Theskinisattachedtotheaponeurosis(seebelow)byverticalstrandsoffibrous
tissuethatbreakupthesubcutaneouslayerintopocketsfilledwithfat.Theblood
vesselsandnerveslieinthislayer,abovetheepicranialaponeurosis(formerly
calledthegaleaaponeurotica).Thisisadensesheetoffibroustissuethatliesin
thedeep
layerofthescalpoverthewholecranium.Itisreallyaflattenedtendonuniting
thefrontalandoccipitalbelliesoftheoccipitofrontalismuscle.

Deeptotheaponeurosisisathinlayeroflooseconnectivetissuethatseparatesit
fromthepericranium,whichistheexteriorperiosteumoftheskull,thedurabeing
theinternalcounterpart.Someveinstraverseallthelayersfromthesuperficial
fasciatothepericranium,andgoontopenetratetheskullandcommunicatewith
theintracranialvenoussinuses,thusformingarouteformeningitisandsinus
thrombosisfrominfectedinjuriesofthescalp.

Epidermis Dermis
Subcutaneous tissue with septa Superficial fascia
Epicranial aponeurosis Loose connective tissue Pericranium (periosteum)
Skull diplo

Lacerationofthescalp
Lacerationsofthescalpbleedprofusely,anddangerousandevenfatalbloodloss
canoccurfromanextensivescalpinjuryifitisnotcheckedbytreatment.The
mostgrossinjuryisavulsionofalargeareaofscalp,whichcanbetornfromthe
head,therebyexposingtheaponeurosisorskull.Thismayhappenifthehair
becomesentangledinmachinery,aswasformerlynotuncommoninwomen
workinginfactories.Amorecommoncausenowadaysisatrafficaccident,where
arotatingvehicletyrecomesintocontactwiththehead,causingaflaying
injurysimilartothatseenonlimbs.
Scalpinjuriesmaybleedprofuselyevenafterdeath,especiallyiftheheadisina
dependentposition.Apostmorteminjurytotheheadmaybleedconsiderablyif
inflictedsoonafterdeathandthesefactsmaysometimescauseconfusionaboutthe
antemortemorpostmortemnatureofthewound,oraboutthelengthoftimeof
survivalfollowingtheinjury.Thereisnoreliablewayofresolvingthisdifficulty.
Lacerationsofthescalpmayreproducethepatternoftheinflictingobject,even
thougharandomsplittingissocommon.Severeblowsfromshapedobjectssuch
ashammersorheavytoolsmayreproducetheprofileoftheweapontotally

orinpart.Acircularfacedhammermaypunchacircleinthescalp,butmore
oftenonlyanarcofacircleisseen.Insuchcases,thepositionoftheedgethat
digsinmostdeeplymaygiveanindicationoftheangleoftheblow.Theremaybe
adepressedfractureoftheunderlyingskullofthesameshapeandsize,thoughthe
interpositionofthedensescalpmaycausetheskulldefecttobeslightlylarger
thantheweapon.Adepressedfractureinthesecircumstancesisnotinevitable,
however,andoneormorelinearfracturesmayradiatefromtheimpactsite.
Thescalpoffersthebestexampleofalaceration,astheskinandsubcutaneous
tissuelieoverthebonyplatformoftheskullandarecrushedagainstitwhenthe
forceimpacts.Infact,scalplacerationscanresembleincisedwounds,becausethis
sandwicheffectissopronouncedthatablowfromabluntinstrumentcancleanly
splitthetissuesagainsttheskull,leavingalinearwoundthatappearstothe
inexperiencedtobeaknifeorchoppercut.
Alacerationcanbedistinguishedfromanincisedwoundby:

thebruisingandcrushingofthemargins,thoughthismaybeaverynarrowzone,
requiringinspectionthroughalens

thepersistenceoftissuestrandsacrosstheinteriorofthewound,includingfascial
bands,vesselsandnerves.Inawoundfromasharpweaponthesearedivided

theabsenceofasharplylinearinjuryintheunderlyingbone,especiallyifitisthe
skull.Aknifeoraxeislikelytochiporscorethebaseofthewound

iftheareaiscoveredwithhair,asonthescalp,intacthairswillsurvivetocross
thewound;anincisedinjurywoulddividethem.
Chop Wounds

Table 13.1: Difference between incised wound and lacerated


wound
S. No. Incised wound Lacerated wound
Any where in the body
Edges are clean cut
No bruising of margins
Blood vessels, nerves clean cut
Hair bulbs clean cut
Bleeding more
Over bony prominences LaceratedBruising present Crushed
Crushed Bleeding less

These types of wounds are produced by a blow with a sharp cutting edge
of a heavy weapon like an axe, basola etc. In this type of injury, the
dimensions of the wound correspond to cross- sections of penetrating
blade. The margins are sharp with lacerated edges.

Chopinjury
Chopinjuriesmaybecausedbyavarietyofimplementsthataregenerallyheavy,and
relativelyblunt,bladedinstruments.Theseincludesomemachetes,Samuraiswordsand
axes.Becauseofthevariabilityoftheblade,injuriessustainedmaybeamixtureof
sharpandbluntforcewounds,typicallyinvolvingbruised,crushedandabradedwound
margins(Figure8.26).Fracturesandamputationsmayalsoresultfromtheuseofsuch
implementsandsubstantialscarringmayensue.

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BLUProf.Dr.R.D.KandouManadoperiodeNovember2011sampaiOktober2012.
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PENELITIANJenispenelitianyangdigunakandalampenelitianiniadalahretrospektif

deskriptif.Subjekpenelitianmeliputisemuapasienpenderitalukabacokyangdirawatdi
RSUPProf.Dr.R.D.KandouManado.TempatpenelitiandilakukandiBagianRekam
MedikRSUPProf.Dr.R.D.KandouManado.PenelitiandilakukanpadabulanOktober
2012Desember2012.Angkakejadian:jumlahpenderitadenganlukabacokdibagian
bedahRSUPProf.Dr.R.D.KandouManadomulaiNovember2011Oktober2012.
Distribusiberdasarkanjeniskelaminpriadanwanita,Distribusifrekuensimenurutumur,
Distribusiberdasarkanpenyebab,Distribusiberdasarkanlokasiluka,Kerusakanorgan
terkait.AlatyangdigunakandalampenelitianAlatTulisMenulis,laptop,Bahanbahan
referensi,CatatanmedikpasienlukabacokdiBagianRekamMedikRSUPProf.Dr.R.
D.Kandou.DenganMelakukankonsultasidengandosenpembimbing,Mengumpulkan
literaturyangberhubungandenganpenelitian,Mengumpulkandatakasussecara
retrospektifdaricatatanmediskorbandibagianbedahdanbagianrekammedicRSU
Prof.Dr.R.D.KandouManadoperiodeNovember2011Oktober2012,Melakukan
pengolahandatayangkemudiandianalisaberdasarkanhasilpresentasenya.