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
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.
AbstrakLukabacokadalahlukaakibatbendatajamataualatberatyangterjadidengan
suatuayunandisertaitenagayangcukupbesar,sehinggaukurandalamlukakuranglebih
samadenganpanjangdariluka.Lukabacokumumnyaterjadipadadaerahyangdapat
terjangkauolehtangankorban.Tujuanpenelitianiniuntukmengetahuigambaranangka
kejadianpenderitalukabacokdiSMFBedahPlastikBLUProf.Dr.R.D.Kandou
ManadoperiodeNovember2011sampaiOktober2012.Penelitianinimengunakan
metoderetrospektifdeskriptifmelaluipenelitiandatarekammedikdiSMFBedahPlastik
BLUProf.Dr.R.D.KandouManadoperiodeNovember2011sampaiOktober2012.
Keseluruhanlukabacoksebanyak52kasus.Kebanyakankasusterjadipadapriayaitu
sebesar84,6%,denganumurterbanyak2130tahun.Biladilihatdaripenyebabluka
seringdisebabkanolehparangdenganlokasidiekstremitassertajugamenyebabkan
kerusakanjaringanpadatulangdantulangrawan.Simpulan:Angkakecelakaanakibat
lukabacoklebihbanyakterjadipadadewasamudakarenasalahsatupenyebab
penggunaanminumankerasberlebihsertaadanyaperselisihan.Tingginyaangkakejadian
iniperlumendapatperhatiandarisemuapihakuntukmenyadaribahayapenggunaan
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sengatanlistrik,ataugigitanhewan.1Secaraumumlukapadakulitterbagiatasluka
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baiksedangkanlukaterbukaterjadikerusakankulit.Penyembuhanlukapadakulit
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lukaberlangsungsecaraberurutanmelaluifasefaseberbagaiprosesyangsalingtumpang
tindihseperti:Faseinflamasiyangberlangsungsekitar35hari,Fasepembentukan
jaringangranulasiyangberlangsungsekitar23minggu,Faseremodelingberlangsung
sekitar12tahun.2Lukakulitsecaraklasikdinyatakansembuhmelaluiproses
penyembuhanprimer(sedikitsekalipembentukanskar)danprosespenyembuhan
sekunderdenganpembentukanskarataukeloid.Lukapadatraumaterjadisekitar1,6juta
kasussetiaptahunnya.Laserasiadalahtipetraumayangseringdijumpai.Kasuslaserasi
terjadisekitar20jutakasussetiaptahun.Merekabiasanyadirawatdiruangbedah,pusat
rawatjalandangawatdarurat.3Salahsatulukayangdisebabkanolehkarenakekerasan
bendatajamyaitulukabacok.Lukabacokumumnyaterjadipadadaerahyangdapat
terjangkauolehtangankorban.Tempatyanglazimadalahleher,dadasebelahkiri,
pergelangantangan,danperut.4Senjatatajamyangdigunakansebagaialatpembunuhan
diJakartasekitar3040%dariseluruhkejadian,dansenjatatajamyangdigunakanuntuk
alatbunuhdirisangatjarang(kuranglebihduakasussetiaptahunnya).5,6,75METODE
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.