Open wounds of the abdominal cavity. Stab wounds Stab wounds

1. CONTUSED WOUND
Description. In the right half of the frontal region, on the border of the scalp, there is a “U”-shaped (when the edges are brought together) wound, with side lengths of 2.9 cm, 2.4 cm and 2.7 cm. In the center of the wound, the skin is peeled off in the form flap on an area of 2.4 x 1.9 cm. The edges of the wound are uneven, edged to a width of up to 0.3 cm, bruising. The ends of the wound are blunt. Tears 0.3 cm and 0.7 cm long extend from the upper corners, penetrating to the subcutaneous base. At the base of the flap there is a strip-shaped abrasion, measuring 0.7x2.5 cm. Taking into account this abrasion, the entire damage as a whole has a rectangular shape, measuring 2.9x2.4 cm. The right and upper walls of the wound are beveled, and the left one is undermined. Tissue bridges are visible between the edges of the damage deep in the wound. The surrounding skin is not changed. In the subcutaneous base around the wound there is a dark red hemorrhage, irregular oval shape, measuring 5.6x5 cm and 0.4 cm thick.
DIAGNOSIS
Bruised wound on the right half of the frontal region.

2. CONCUSSION WOUND
Description. In the right parietal-temporal part, 174 cm from the plantar surface and 9 cm from the anterior midline, in an area of 15x10 cm, there are three wounds (conventionally designated 1,2,3).
The wound 1. is spindle-shaped, measuring 6.5 x 0.8 x 0.7 cm. When the edges are brought together, the wound takes on a rectilinear shape, 7 cm long. The ends of the wound are rounded, oriented at 3 and 9 o'clock.
The upper edge of the wound is edged to a width of 0.1-0.2 cm. The upper wall of the wound is beveled, the lower one is undermined. The wound in the middle part penetrates to the bone.
Wound 2, located 5 cm downwards and 2 cm posterior to wound N 1, has a star-shaped shape, with three rays oriented at 1. 6 and 10 of the conventional clock dial, lengths 1.5 cm, 1.7 cm and 0. 5 cm, respectively. The overall dimensions of the wound are 3.5x2 cm. The edges of the wound are edged to a maximum width in the area of the front edge - up to 0.1 cm, in the rear - up to 1 cm. The ends of the wound are sharp. The front wall is undermined, the back wall is beveled.
Wound 3 is similar in shape to wound No. 2 and is located 7 cm upward and 3 cm anterior to wound No. 1. The length of the rays is 0.6, 0.9 and 1.5 cm. The overall dimensions of the wound are 3x1.8 cm. Edges the wounds are closed to a maximum width in the area of the anterior edge - up to 0.2 cm, in the posterior - up to 0.4 cm.
All wounds have uneven, bruised, crushed, bruising edges, and tissue bridges at the ends. The outer boundaries of sedimentation are clear. The walls of the wounds are uneven, bruised, crushed, with intact hair follicles. The greatest depth of the wounds is in the center, up to 0.7 cm in wound No. 1 and up to 0.5 cm in wounds No. 2 and 3. The bottom of wounds No. 2 and 3 is represented by crushed soft tissue. In the subcutaneous area around the wounds there are hemorrhages, irregular oval shape, measuring 7x3 cm in wound No. 1 and 4 x 2.5 cm in wounds No. 2 and 3. The skin around the wounds (beyond the edges) is not changed.
DIAGNOSIS
Three bruised wounds on the right parietotemporal part of the head.

3. lacerated wound
Description. On the right half of the forehead, 165 cm from the level of the plantar surface of the feet and 2 cm from the midline, there is an irregular spindle-shaped wound, measuring 10.0 x 4.5 cm, with a maximum depth of 0.4 cm in the center. The length of the damage is located according to the 9-3 conventional clock dial. When comparing the edges, the wound takes on an almost linear shape, without a tissue defect, 11 cm long. The ends of the wound are sharp, the edges are uneven, without sedimentation. The skin at the edges of the wound is unevenly peeled off from the underlying tissues to a width of: 0.3 cm - along the upper edge; 2 cm - along the bottom edge. In the resulting “pocket” a flat dark red blood clot is detected. The hair at the edges of the wound and their hair follicles are not damaged. The walls of the wound are steep, uneven, with small focal hemorrhages. There are tissue bridges between the edges of the wound in the area of its ends. The bottom of the wound is the partially exposed surface of the scales of the frontal bone. The length of the wound at the level of its bottom is 11.4 cm. Parallel to the length of the wound, the finely jagged edge of a fragment of the frontal bone protrudes into its lumen by 0.5 cm, on which there are small focal hemorrhages. No damage was detected on the skin or underlying tissues around the wound.
DIAGNOSIS
Laceration on the right side of the forehead.

4. BITE DAMAGE TO SKIN
Description. On the anterior outer surface of the upper third of the left shoulder in the area of the shoulder joint there is an unevenly expressed red-brown ring-shaped deposit of irregular oval shape measuring 4x3.5 cm, consisting of two arched fragments: upper and lower.
The upper fragment of the abrasion ring has dimensions of 3x2.2 cm and a radius of curvature of 2.5-3 cm. It consists of 6 banded, unevenly expressed abrasions ranging in size from 1.2x0.9 cm to 0.4x0.3 cm, partially connected to each other. Centrally located abrasions have the maximum size, while the minimum size is along the periphery of the abrasion, especially at its upper end. The length of the abrasions is directed predominantly from top to bottom (from the outer to the inner border of the semi-oval). The outer edge of the sedimentation is well defined, has the appearance of a broken line (step-like), the inner edge is sinuous and indistinct. The ends of the deposit are U-shaped, the bottom is rather dense (due to drying out), with an uneven banded relief (in the form of ridges and grooves running from the outer border of the semi-oval to the inner). The deposits are deep (up to 0.1 cm) at the upper edge.
The lower fragment of the ring has dimensions of 2.5x1 cm and a radius of curvature of 1.5-2 cm. Its width ranges from 0.3 cm to 0.5 cm. The outer border of sedimentation is relatively smooth and somewhat smoothed, the inner one is sinuous and more distinct, especially on its left side. Here the inner edge of the sedimentation has a steep or somewhat undermined character. The ends of the settling are U-shaped. The bottom is dense, grooved in shape, deepest at the left end of the sedimentation. The bottom relief is uneven, there are 6 sinking sections located in a chain along the course of the abrasion, irregular rectangular shape with dimensions from 0.5 x 0.4 cm to 0.4 x 0.3 cm and a depth of up to 0.1-0.2 cm.
The distance between the internal boundaries of the upper and lower fragments of the sedimentation “ring” is: on the right - 1.3 cm; in the center - 2 cm; on the left - 5 cm. The symmetry axes of both semirings coincide with each other and correspond to the long axis of the limb. In the central zone of the ring-shaped sedimentation, a blue bruise of irregular oval shape measuring 2 x 1.3 cm with unclear contours is determined.
DIAGNOSIS
Abrasions and bruising on the anterior outer surface of the upper third of the left shoulder.

5. CUT WOUND
Description. On the flexor surface of the lower third of the left forearm, 5 cm from the wrist joint, there is a wound (conventionally designated N 1) of irregular fusiform shape, dimensions 6.5 x 0.8 cm, with a length of 6.9 cm when the edges are brought together. From the outer (left) from the end of the wound, 2 incisions extend parallel to its length, 0.8 cm and 1 cm long with smooth edges ending in sharp ends. At 0.4 cm from the lower edge of wound No. 2, parallel to its length, there is a superficial intermittent incision 8 cm long. The bottom of the wound at its inner (right) end has the greatest steepness and depth of up to 0.5 cm.
2 cm down from the first wound there is a similar wound No. 2), measuring 7x1.2 cm. The length of the wound is oriented horizontally. When the edges are brought together, the wound takes on a rectilinear shape, 7.5 cm long. Its edges are wavy, without settling or crushing. The walls are relatively smooth, the ends are sharp. At the inner (right) end of the wound, parallel to the length, there are 6 skin incisions ranging from 0.8 to 2.5 cm in length, at the outer end there are 4 incisions, 0.8 to 3 cm in length. The bottom is represented by dissected soft tissue and has the greatest steepness and the depth at the outer (left) end of the wound is up to 0.8 cm. In the depth of the wound, a vein is visible, on the outer wall of which there is a through spindle-shaped damage, measuring 0.3x0.2 cm.
In the tissues surrounding both wounds, in an oval-shaped area measuring 7.5x5 cm, there are multiple dark red hemorrhages merging with each other, irregular oval in shape, measuring from 1x0.5 cm to 2x1.5 cm with uneven, fuzzy contours.
DIAGNOSIS
Two incised wounds of the lower third of the left forearm.

6. STAB WOUND
Description.
On the left half of the back, 135 cm from the plantar surface of the feet, there is an irregular spindle-shaped wound measuring 2.3 x 0.5 cm. The length of the wound is oriented at 3 and 9 on the clock dial (provided the body is in the correct vertical position). After bringing the edges together, the wound has a rectilinear shape, 2.5 cm long. The edges of the wound are smooth, without bruising or bruising. The right end is U-shaped, 0.1 cm wide, the left is in the form of an acute angle. The skin around the wound is without damage or contamination.
On the posterior surface of the lower lobe of the left lung, 2.5 from its upper edge, a slit-shaped injury is located horizontally. When the edges are brought together, it acquires a rectilinear shape, 3.5 cm long. The edges of the damage are smooth, the ends are sharp. The lower wall of the damage is beveled, the upper one is undermined. On the inner surface of the upper lobe of the lung at the root, 0.5 cm of the damage described above, there is another (slit-shaped with smooth edges and sharp ends). There are hemorrhages along the wound channel.
Both injuries are connected by a straight single wound channel, directed from back to front and from bottom to top (provided the body is in the correct vertical position). The total length of the wound channel (from the wound on the back to the damage to the upper lobe of the lung) is 22 cm.
DIAGNOSIS
A blind stab wound to the left half of the chest, penetrating into the left pleural cavity, with perforating damage to the lung.

7. CHOPPED WOUND
Description. On the anterior internal surface of the lower third of the right thigh, 70 cm from the plantar surface of the feet, there is a gaping wound of irregular spindle-shaped shape, measuring 7.5x1 cm. After bringing the edges together, the wound takes a straight shape, 8 cm long. The edges of the wound are smooth, crusted, bruised, the walls are relatively smooth. One end of the wound is U-shaped, 0.4 cm wide, the other in the form of an acute angle. The wound channel is wedge-shaped and has the greatest depth of up to 2.5 cm at its U-shaped end, ending in the thigh muscles. The direction of the wound canal is from front to back, from top to bottom and from left to right (provided that the body is in the correct vertical position) The walls of the wound canal are even and relatively smooth. In the muscles around the wound channel there is an irregular oval-shaped hemorrhage, measuring 6x2.5x2 cm.
On the anterior surface of the internal condyle of the right femur there is a wedge-shaped damage, measuring 4x0.4 cm and up to 1 cm deep, its length is oriented according to the 1-7 conventional clock dial (provided the correct vertical position of the bone). The upper end of the damage is U-shaped, 0.2 cm wide, the lower end is sharp. The edges of the damage are even, the walls are smooth.
DIAGNOSIS
A chopped wound of the right thigh with a cut in the internal condyle of the femur.

8. BURN BY FLAME
Description. On the left half of the chest there is a red-brown wound surface, irregular oval shape, measuring 36 x 20 cm. The area of the burn surface, determined by the “palms” rule, is 2% of the total surface of the victim’s body. The wound is covered in places with a brownish scab, rather dense to the touch. The edges of the wound are uneven, coarsely and finely wavy, somewhat raised above the level of the surrounding skin and wound surface. The greatest depth of the lesion is in the center, shallower - along the periphery. Most of the burn surface is represented by exposed subcutaneous tissue, which has a moist, shiny appearance. In some places, red small focal hemorrhages are detected, oval in shape, ranging in size from 0.3 x 0.2 cm to 0.2 x 0.1 cm, as well as small thrombosed vessels. In the central part of the burn wound there are separate areas covered with greenish-yellow purulent deposits, which alternate with pinkish-red areas of young granulation tissue. In some places, soot deposits are visible on the wound surface. The vellus hairs in the wound area are shorter, their ends are “flask-shaped” swollen. When dissecting a burn wound in the underlying soft tissues, pronounced edema is detected in the form of a gelatinous yellowish-gray mass, up to 3 cm thick in the center.
DIAGNOSIS
Thermal burn (flame) of the left half of the chest, III degree, 2% of the body surface.

9. HOT WATER BURN
Description. On the front surface of the right thigh there is a burn wound of irregular oval shape, measuring 15x12 cm. The area of the burn surface, determined by the “palms” rule, is 1% of the entire surface of the victim’s body. The main part of the burn surface is represented by a group of merging blisters containing a cloudy yellowish-gray liquid. The bottom of the bubbles is the uniform pink-red surface of the deep layers of the skin. Around the blistering zone there are areas of skin with a soft, moist, pinkish-reddish surface, on the border of which there are zones of peeling of the epidermis with filmy exfoliation up to 0.5 cm wide. The edges of the burn wound are coarse and finely wavy, slightly raised above the level of the surrounding skin, with “tongue-like” protrusions, especially downward (provided the hip is in the correct vertical position). The vellus hair in the wound area is not changed. When dissecting a burn wound in the underlying soft tissues, pronounced edema is detected in the form of a gelatinous yellowish-grayish mass, up to 2 cm thick in the center.
DIAGNOSIS
Thermal burn with hot liquid on the anterior surface of the right thigh, II degree, 1% of the body surface.

10. THERMAL FLAME BURN IV DEGREE
In the area of the chest, abdomen, buttocks, external genitalia and thighs there is a continuous burn wound of irregular shape with wavy, uneven edges. Wound boundaries: on the left chest - subclavian region; on the chest on the right - costal arch; on the back on the left - the upper part of the scapular region; on the back on the right - lumbar region; on the legs - the right knee and the middle third of the left thigh. The wound surface is dense, red-brown, and black in places. At the border with intact skin there is a stripe-like redness up to 2 cm wide. The vellus hair in the wound area is completely singed. On incisions in the underlying soft tissues there is pronounced gelatinous yellow-gray swelling up to 3 cm thick.

11. SUFFERED BURN BY LIGHTNING
In the occipital region in the center there is a round dense light gray scar 4 cm in diameter with thinning skin, fused to the bone. The boundaries of the scar are smooth, rising in a roller-like manner when transitioning to intact skin. There is no hair in the scar area. On internal examination: Scar thickness is 2-3 mm. There is a round defect of the external bone plate and cancellous substance 5 cm in diameter with a flat, relatively flat and smooth, similar to a “polished” surface. The thickness of the bones of the cranial vault at the cut level is 0.4-0.7 cm, in the area of the defect the thickness of the occipital bone is 2 mm, the internal bone plate is not changed.

Penetrating injuries, wounds penetrating into cavities
12. STAB WOUND
Description. On the left half of the chest, along the midclavicular line in the IV intercostal space, there is a wound located longitudinally, irregularly fusiform in shape, measuring 2.9x0.4 cm. The upper part of the wound is rectilinear, 2.4 cm long; the lower one is arched, 0.6 cm long. The edges of the wound are even and smooth. The upper end of the wound is U-shaped, 0.1 cm wide, the lower end is sharp.
The wound penetrates the pleural cavity with damage to the left lung. The total length of the wound channel is 7 cm, its direction is from front to back and slightly from top to bottom (with
condition of correct vertical body position). There are hemorrhages along the wound channel.
DIAGNOSIS
A stab wound to the left half of the chest, penetrating into the left pleural cavity with damage to the lung.

13. BULLET WOUND
On the chest, 129 cm from the level of the soles, 11 cm below and 3 cm to the left of the sternal notch, there is a round wound 1.9 cm in size with a tissue defect in the center and a circular band of subsidence along the edge, up to 0.3 cm wide. Edges of the wound uneven, scalloped, the lower wall is slightly beveled, the upper wall is undermined. The organs of the chest cavity are visible at the bottom of the wound. Along the lower semicircle of the wound, soot is deposited on a semilunar-shaped area, up to 1.5 cm wide. On the back, 134 cm from the level of the soles, in the area of the 3rd left rib, 2.5 cm from the line of the spinous processes of the vertebrae, there is a slit-like wound shapes (without fabric defects) 1.5 cm long with uneven, finely patchwork edges, turned outward and rounded ends. A white plastic fragment of a cartridge container will protrude from the bottom of the wound.

Examples of descriptions of fracture injuries:
14. Rib FRACTURE
There is an incomplete fracture on the 5th rib on the right between the angle and the tubercle, 5 cm from the articular head. On the inner surface, the fracture line is transverse, with smooth, well comparable edges, without damage to the adjacent compact substance; the fracture zone gapes slightly (signs of stretching). Near the edges of the rib, this line bifurcates (at the upper edge at an angle of about 100 degrees, at the lower edge at an angle of about 110 degrees). The resulting branches move to the outer surface of the rib and gradually, becoming thinner, are interrupted near the edges. The edges of these lines are finely jagged and not tightly comparable, the walls of the fracture in this place are slightly beveled (signs of compression.)

15. MULTIPLE RIB FRACTURES
Ribs 2-9 are broken along the left midaxillary line. The fractures are of the same type: on the outer surface the fracture lines are transverse, the edges are smooth, tightly comparable, without damage to the adjacent compact (signs of stretching). On the inner surface, the fracture lines are oblique and transverse, with coarsely jagged edges and small flakes and visor-shaped bends of the adjacent compact substance (signs of compression). From the zone of the main fracture along the edge of the ribs there are longitudinal linear splits of the compact layer, which become hair-like and disappear. Along the scapular line on the left, 3-8 ribs are broken with similar signs of compression on the outer surfaces and stretching on the inner surfaces described above.

Stab wounds of the abdominal wall can be caused by both blunt and sharp objects. This difference in the nature of the wounded object does not have much practical significance in the modern development of surgery.

The main question remains extremely important: whether such a wound penetrates or does not penetrate the abdominal cavity. A positive solution to the question of its penetration into the abdominal cavity, as well as doubts in this regard, dictate the need for diagnostic transection. As a rule, it is more expedient to carry it out through the so-called progressive expansion of the wound with revision of the internal organs. However, in some cases, mainly in cases of severe contamination or significant crushing of the wound tissue, it may be more advantageous to perform a diagnostic transection away from the wound, most often along the midline of the abdomen.

When there is no doubt that this stab wound of the abdominal wall is non-penetrating, the first task is PSO of the wound, with complete excision of the affected tissue, careful hemostasis, and suturing the integument tightly or using short-term subcutaneous thin tubes. It should be remembered that wounds of the abdominal wall require no less pedantic prophylactic administration of antitetanus serum than wounds of other parts of the body. When treating a wound, after excision of tissues of questionable viability, care should be taken to restore the integrity of the muscular aponeurotic layers of the abdominal wall by suturing their edges or even moving them nearby. In the future, it is necessary to keep the patient in bed for a number of days and not to weaken monitoring of him in terms of identifying previously unnoticed signs of damage to internal organs and monitoring the possible development of infection.

Injuries to the abdominal walls in the upper sections of the rectus muscles, accompanied by injuries to the branches of the superior epigastric artery, and in the lower sections of the inferior epigastric artery, can cause heavy bleeding, requiring urgent ligation of the artery in the wound.

Among non-penetrating wounds of the abdominal wall, bite wounds are sometimes found. Since they are most often inflicted by dogs, sometimes by wolves or other animals, then, in addition to following the usual rules of surgical treatment, they require anti-rabies vaccinations (in dosages indicated by the Pasteur station).

The prognosis for non-penetrating stab wounds of the abdominal wall is favorable in most cases; however, the possibility of developing tetanus, anaerobic infection, putrefactive lymphangitis, and sometimes sepsis can occasionally cloud the outcome. For the purpose of prevention, if you suspect the possibility of developing these complications, after surgical treatment of the wound, such victims should be kept in bed for a number of days.

The article was prepared and edited by: surgeon

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Open or penetrating wounds to the abdominal cavity are most often caused by firearms or cutting and stabbing objects.

In the practice of surgeons, the most common penetrating abdominal wounds are gunshot and stab wounds. In such patients, an examination of the abdomen is carried out immediately after restoration of airway patency, adequate breathing and blood circulation. Indications for laparotomy are set based on signs of damage to internal organs requiring surgical treatment. Urgent surgical intervention is required for patients in a state of shock and with signs of peritonitis, patients in whom blood is released through a nasogastric tube or from the rectum, patients in whom free gas is detected in the abdominal cavity or in the retroperitoneal space, patients in whom internal organs are visible, as well as those taken to the hospital with a knife stuck in their stomach. In such cases, intravenous urography (IVP) is urgently performed, which can quickly identify the presence of two functioning kidneys. Intravenous urography is performed not so much to detect damage to the urinary system, but to make sure that the kidney on the undamaged side is functioning well (extremely necessary information in cases where the question of performing a nephrectomy arises during surgery).

Diagnosis in patients with gunshot wounds is quite simple. In contrast, the penetrating nature of stab wounds is more difficult to establish. These two types of penetrating abdominal wounds will be described below.

Gunshot wounds, in which the projectile penetrates the body from the chest to the hips, can cause damage to the abdominal organs. Of all penetrating gunshot wounds to the abdomen, 98% cause internal organ damage that requires immediate surgical intervention. However, in some cases, the nature of the gunshot wound may cause doubts among doctors. This situation occurs mainly with tangential gunshot wounds to the abdomen. In such cases, laparocentesis is performed, and if the examination of the fluid obtained from the abdominal cavity during peritoneal lavage reveals more than 10.0 × 1012 red blood cells/l, the wound is penetrating and emergency laparotomy is required. Gunshot wounds of the thoracoabdominal region, back, lateral abdomen and pelvic region, which cause doctors to doubt their penetrating nature, are quite rare. In such cases, diagnostic tactics should be the same as for stab wounds of the abdomen.

For stab wounds of the anterior abdominal wall, doctors’ tactics may be different. It is always important to remember that only 50% of all abdominal stab wounds penetrate the abdominal cavity, and only 50% of them cause internal organ damage requiring emergency surgical intervention. In our opinion, the main task of examining such patients is to identify victims who have indications for emergency surgical intervention. Such patients must be quickly prepared for surgery. Conscious patients with stable hemodynamic parameters can be examined several times over time so as not to miss a penetrating wound. If they show signs of developing peritonitis or shock, surgery is necessary. All other patients can be discharged from the hospital after 24-48 hours. Examples when, during dynamic observation and examination, doubts about the diagnosis remain are quite rare. In these cases, many authors recommend using all possible diagnostic techniques, including laparocentesis and peritoneal lavage, local wound exploration (debridement and revision), diagnostic laparoscopy, and, finally, diagnostic laparotomy. Of all these techniques, the most informative for diagnosing a penetrating abdominal wound and setting indications for emergency surgical intervention, in our opinion, is laparocentesis and peritoneal lavage. There are three types of abdominal stab wounds that present significant diagnostic difficulties. These are thoracoabdominal wounds, wounds of the back and lateral abdomen. With thoracoabdominal wounds, the wound channel can enter the chest and penetrate through the diaphragm into the abdominal cavity. In this case, abdominal organs can often be damaged. The presence in such patients of signs of wound penetration into the abdominal cavity is an indication for emergency surgery. When examining these cases, we used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 × 1012/l was evidence of the penetrating nature of the injury. In such cases, drainage of the pleural cavity and laparotomy were performed, during which the defect in the diaphragm was sutured, and then adequate surgical intervention was performed, depending on the damage found in the abdominal cavity. Stab wounds of the back and lateral abdomen can cause both damage to the retroperitoneal organs and the abdominal cavity. Injuries to the retroperitoneal part of the duodenum and colon are especially dangerous. In such patients, we also used laparocentesis and peritoneal lavage. The presence of erythrocytes in the fluid coming from the abdominal cavity in an amount of more than 10.0 × 1012/l indicates the penetrating nature of the injury. In such cases, emergency laparotomy was performed to eliminate damage to the abdominal organs and retroperitoneum. If the content of red blood cells in the fluid obtained from the abdominal cavity during peritoneal lavage was less than 10.0 × 1012/l, we performed a computed tomography scan of the abdomen with the introduction of a contrast agent intravenously, into the duodenum and into the colon. With this method of computed tomography with “triple” contrast, the accuracy of the method in diagnosing damage to the organs of the retroperitoneal space is more than 95%. Stab wounds of the pelvis can cause damage to the organs of the gastrointestinal tract, organs of the urinary system, as well as the internal genital organs in women. To identify the penetrating nature of the wound, we also used laparocentesis and peritoneal lavage. In addition, all patients with stab wounds of the pelvic region underwent rigid proctosigmoidoscopy (sigmoidoscopy), cysto-urethrography, and women, in addition, underwent a vaginal speculum examination. Moreover, if the content of erythrocytes in the fluid obtained from the abdominal cavity exceeded 10.0 × 1012/l, or other studies revealed signs of damage to internal organs, emergency surgery was performed. All other patients were followed up.

Most often, with penetrating stab wounds of the abdomen, the liver (in 37% of cases), spleen (7%) and kidneys (5%) are damaged from parenchymal organs. However, in general, hollow organs are most often damaged by stab and penetrating wounds of the abdomen. Their hollow organs are most often damaged in the small intestine (26% of cases), stomach (19%) and large intestine (16.5%).

Expert's conclusion No. -09M

In the period from April 30 to May 4, 2009, on the basis of a written statement from the lawyer of the Bar Chamber of the Republic of Dagestan (lawyer's office) M.I. Javadov. dated 04/02/2009 for ref. No. 16-09, specialist in the field of forensic medicine, Honored Doctor of the Russian Federation, Candidate of Medical Sciences Sergey Mikhailovich ZOSIMOV, who has a higher medical education, special training in forensic medicine, including forensic traumatology, a specialist certificate and the highest qualification category in the specialty " forensic medical examination", work experience in this specialty since 1965, studied the photocopy of expert report No. 50 dated December 26, 2006 - January 26, 2007 presented by the lawyer (examination of the corpse of a citizen born in 1962, to answer the questions asked.

Questions posed to the specialist

1. Do the number of injuries on the body of —————- in the form of stab wounds found and indicated in the conclusion of the forensic medical examination No. 50 dated December 28, 2006 and in a photocopy of the emergency operating log of the surgical department of the Derbent Central City Hospital correspond? ——————.and do they coincide in localization? If not, what kind of bodily injuries are not reflected in the conclusion of the medical examination?

2. What is the likely sequence of infliction————————. stab wounds?

3. Do the medical data on the location, nature and characteristics of the injuries established during the examination of the corpse correspond to the testimony of the accused————————. about the method of causing the damage that led to the death of the victim?

4. What, at the time of infliction of the stab wounds, is his most likely relative position in relation to the attacker?

5. Is a forensic expert authorized to single-handedly draw conclusions on the questions posed, or is it necessary to conduct a commission or comprehensive examination with the involvement of specialists from another field?

Facts of the case

From a written statement by lawyer M.I. Javadov. in the name of the head of the Center for Medical and Forensic Research it is known: “...December 27, 2006, at approximately 18 o’clock, in the city. Derbent of the Republic of Dagestan on the street. 345 DSD near house No. 10 —————-were caused by————————, born in 1962, multiple stab wounds, from which he died in the Derbent Central City Hospital of the Republic of Dagestan on December 28, 2006.

Cloth---------. was lost during the preliminary investigation, and his medical history was also lost. By clothing————————-. no examination was carried out for the reasons stated above.

December 28, 2006 for the corpse————————. a forensic medical examination was carried out, which was completed on January 26, 2006.

According to the conclusion of the forensic medical examination of the corpse ———————No. 50, the following penetrating wounds were found on it:

- a wound in the left half of the chest at the level of the 2nd and 3rd ribs along the midclavicular line, penetrating into the left pleural cavity with damage to the upper lobe of the left lung;

— a wound in the area of the 5th intercostal space, penetrating into the left pleural cavity with damage to the heart;

- wound in the 6th intercostal space along the anterior axillary line, which
penetrates the left pleural cavity with damage to the lung and heart;

— a wound on the posterior surface of the chest along the scapular line on the left, penetrating into the pleural cavity with damage to the lower lobe of the left lung;

- wound in the area of the left superciliary arch.

Considering that the edges of the above wounds are even, smooth, have a linear shape, the ends of the wounds are sharp, these injuries were caused by a piercing-cutting object such as a knife, they are classified as serious and have a direct causal connection with death, caused by one weapon.

3. On the body of the corpse gr.———————. A total of 5 (five) stab wounds were found, of which 4 wounds were on the left side of the chest and one wound in the area of the left brow ridge.

4. At the time of infliction of the above injuries, the victim could have been in a vertical position or closer to it, and during the infliction of 2,3,4 wounds (damages), the position of the body could change, i.e. he could be in any position: sitting, lying on his back, face down, etc.

5. Medical and forensic examination of 3 areas of skin ————————one through wound was established for each. These wounds are stab wounds and are caused by the effects of a flat single-edged blade of a piercing-cutting weapon, characterized by the presence of pronounced ribs of the butt, having a maximum width of the immersed part of no more than 17-18 mm.

According to a photocopy of the operating journal of the surgical department of the Derbent Central City Hospital (CHH) RD, the postoperative diagnosis for ————————————-, born in 1962, is as follows: “Penetrating multiple wounds into the pleural cavity on the left (three), two perforating heart wounds. Cardiac tamponade. Multiple wounds to the left lung (5 wounds). Hematox on the left. Hemorrhagic shock 3 tbsp. (clinical death)"

We cannot provide a medical history due to her loss.

From the defendant's testimony————————. in court on February 6, 2009: “...he and I (———————) grabbed hold. That day there was ice and I fell on my back, he (————————) ended up on top of me and began to choke me. When I began to choke from his grip, I felt for a knife under my hand, grabbed it and began to swing it. I didn't want to kill him. Then I felt his grip on my neck loosen and he moved away from me. I headed towards the Magrad beer bar. And the next day I found out that this guy died.”

Investigative experiment to verify the testimony of the guilty person ————————-to determine the possibility of causing bodily harm——————————. and the mechanism of their formation and localization has not been carried out.

Study

1. From a photocopy of expert opinion No. 50 dated December 23, 2006 – January 26, 2007.(examination of the corpse) it is known that the state forensic expert of the Republican Bureau of Forensic Medical Examination of the Republic of Dagestan————————-. On the premises of the Derbent medical examiner's office, he carried out a forensic medical examination of the corpse —————————-born in 1962. The expert's report contains the following information:

«… Ask the expert questions:

– What bodily injuries are there on the body———————., what is their nature, mechanism and age of formation, what kind of health harm does it relate to and what is the sequence of damage?

— Was the victim capable of performing any independent actions after the injury was caused - moving, screaming, etc.?

— What weapon, one or more, and how exactly was the damage caused?———————.?

— What is the shape of the piercing weapon that caused the damage, the cross-sectional dimensions and approximate length?

— What was the most likely mutual position———————. and the attacker at the time the first received bodily injuries?

— What is the cause of death——————. and what exact injury was the cause of death?

— Did the victim take alcoholic beverages shortly before his death? If he did, to what extent was he intoxicated?

— What is the blood group of the victim?

Medical document data:

From the history and illness No. 048-7Р addressed to —————-. Born 1962 It is known that he was taken by ambulance to the intensive care unit of the Central City Hospital of Derbent on December 27, 2006 at 18.25. in an agonal state. Blood pressure 0/0 mm Hg. The patient was immediately taken to the operating room. When the patient was transferred from the stretcher to the operating table, clinical death occurred. A closed heart massage was performed and connected to mechanical breathing. Cardiac activity was restored after 15-20 minutes. 12/27/06 Surgery - left thoracotomy, drainage of the pleural cavity. Under intubation anesthesia, a thoracotomy was performed in the 5th intercostal space on the left. There is about 2.5-3 liters of blood in the pleural cavity, cardiac tamponade. The pericardium was urgently opened. About 1500-2000 g were released from the pericardial cavity. (!) blood. In the area of the left ventricle there are two through wounds measuring 1.5x1 cm with jet bleeding in the form of a fountain. Bleeding heart wounds are covered with a finger and stitches are applied. Blood from the pleural cavity is collected for reinfusion. Blood clots were removed from the pleural cavity. When examining the lungs, there were about 5 lung injuries. The lung tissue in the wounded area is extensively imbibed with blood. Lung wounds were sutured with continuous sutures. The chest wounds on the inside were sutured. Further inspection revealed no other damage. The pleural cavity is dried, drained into the 8th intercostal space on the left along the posterior axillary line and into the 2nd intercostal space along the midclavicular line. Wound hemostasis. Layer-by-layer sutures on the wound, bandage. Postoperative diagnosis: Multiple penetrating wounds into the pleural cavity on the left (three). Two perforating heart wounds. Cardiac tamponade. Multiple wounds to the left lung (five wounds). Hemothorax on the left. Hemorrhagic shock 3 tbsp. (clinical death). On December 28, 2006, at 15:00, death was pronounced... External research. The corpse of a man of correct physique, satisfactory nutrition, body length 172 cm... Damage: In the area of the left half of the chest, at the level of the 2-3 ribs along the midclavicular line, a wound measuring 1.8 x 0.2 cm with two sutures was detected, at 3 and 9 o’clock. The distance from the plantar (surface of the feet) to the above wound is 135 cm (skin flap taken for MCO). In the area of the 4th rib on the left there is a postoperative wound... with 20 stitches. 1 cm below the specified postoperative scar along the midclavicular line, a wound measuring 1.5x1.2 cm with 1 suture applied at 3 and 9 o’clock with smooth edges and sharp ends is determined. The distance from the plantar surface to the above wound is 124 cm (the skin flap was taken for MCO). At the level of the 6th rib on the left half of the chest along the anterior axillary line, there is a wound measuring 1.5x0.2 cm with two sutures at 12 and 6 o'clock. The distance from the plantar surface to the above wound is 121 cm. At the level of the 8th rib, the wound measures 1.56x1.5 cm (from the drainage tube) along the posterior axillary line. On the back surface of the chest in the area of the lower corner of the left scapula there is a wound measuring 1.5x0.3 cm (MKO). On the left parietal area there is a bruise measuring 6x5 cm. In the area of the middle of the forehead there is an abrasion measuring 1.5x0.5 cm. In the area of the right knee there is an abrasion measuring 3x4 cm in red color. In the area of the left superciliary arch there is a wound measuring 1.5x0.2 cm with two sutures. In the area of the upper eyelid of the left eye there was a blue bruise measuring 5x1.5 cm. Internal research...According to the isolation of the organ complex, the bones of the ribs, pelvis, and spine are intact. In the area of the 3rd intercostal space there is a wound measuring 1.8x0.2 cm, at the level of the 4th and 5th intercostal spaces there is a wound measuring 1.5x0.2 cm, at the level of the 6th intercostal space there is a wound measuring 1.5x0.2 cm. The surrounding soft tissues of the above wounds are soaked in blood... Similar a wound on the posterior surface of the chest on the left at the level of the 7th and 8th intercostal space measuring 1.5x0.3 cm. All of the above wounds penetrate into the pleural cavity... On the anterior surface of the upper lobe of the left lung two wounds with sutures are identified; in the area of the oblique fissure of the left lung there is a wound with a suture. On the posterior surface of the left lung there is a wound in the projection of 7.8 ribs with sutures applied, the course of the wound channel goes from back to front, from left to right, slightly from top to bottom, the total length of the wound is 12-15 cm... On the anterior lateral surface of the heart sac there is a wound measuring 7x0.2 cm with sutures. The heart measures 11x7x4 cm, on the anterior lateral surface of the left ventricle there are two wounds with sutures, the sutures are strong... Forensic diagnosis: Multiple blind penetrating stab wounds of the left half of the chest with damage to the cardiac membrane, heart, and left lung. Hemorrhages into the left pleural cavity (2500 ml) and into the pericardial cavity (150 ml). Acute blood loss. Anemia of internal organs and tissues. Stab wound of the left superciliary ridge. Hemorrhage (bruise) in the left parietal region, upper eyelid of the left eye. Abrasions in the forehead and anterior surface of the left knee joint...

Data from additional research methods…

During a forensic chemical examination of blood from a corpse————-. ethyl alcohol was found in a concentration of 0.6% 0 ...

Medical and forensic examination of 3 areas of the skin of a corpse———————. One through wound of each was established. These wounds are stab wounds and are caused by the impact of a flat single-edged blade of a piercing-cutting weapon, characterized by the presence of pronounced ribs of the butt, having a maximum width of the immersed part of no more than 17-18 mm...

Blood of the deceased——————. belongs to the AB group...

conclusions

1. When examining the corpse of gr. ———————. discovered: a wound in the area of the left half of the chest at the level of the 2nd and 3rd ribs along the midclavicular line, penetrating into the left pleural cavity with damage to the upper lobe of the left lung. In the area of the 5th intercostal space there is a wound penetrating into the left pleural cavity with damage to the heart. In the area of the 6th intercostal space along the anterior axillary line there is a wound that penetrates into the left pleural cavity with damage to the lung and heart. On the posterior surface of the chest along the scapular line on the left there is a wound penetrating into the pleural cavity with damage to the lower lobe of the left lung. Wound in the area of the left brow ridge. Considering that the edges of the above wounds are even, smooth, have a linear shape, the ends of the wounds are sharp, these injuries were caused by a piercing-cutting object such as a knife, they are classified as serious and have a direct causal connection with death, caused by one weapon. Damage found on the citizen's body———————. in the form of bruises and abrasions caused by a blunt and hard object with a limited contact surface. All of the above damages were caused within the period specified in the resolution and are intravital.

2. Death of the citizen———————-. violent, occurred from penetrating wounds of the left half of the chest with damage to the heart, left lung, hemorrhagic shock (acute blood loss).

3. On the body of the corpse gr. ————————a total of five stab wounds were found, of which 4 were wounds on the left side of the chest and one wound in the area of the left brow ridge.

4. After the above injuries were inflicted, the victim could perform independent actions - move, scream, from several seconds to several minutes.

5. At the time of infliction of the above injuries, the victim could be in a vertical position or closer to it, and during the infliction of 2,3,4 wounds (damages), the position of the body could change, that is, he could be in any position - sitting, lying on his back, face down, etc.

6. During a forensic chemical examination of blood from a corpse————-. ethyl alcohol was found in a concentration of 0.6% 0 ...

7. Blood of the deceased——————. belongs to the AB group...

8. Medical and forensic examination of 3 areas of the skin of a corpse———————. One through wound of each was established. These wounds are stab wounds and are caused by the impact of a flat single-edged blade of a piercing-cutting weapon, characterized by the presence of pronounced ribs of the butt, having a maximum width of the immersed part of no more than 17-18 mm...

2. From a photocopy of the operating log dated December 27, 2006. known: “...full name –————————. Age – 1982, Date of operation – December 27, 2006…Operation – left thoracotomy, drainage of the pleural cavity. Under intubation anesthesia, a thoracotomy was performed in the 5th intercostal space on the left. There is about 2.5-3 liters of blood in the pleural cavity, cardiac tamponade. The pericardium was urgently opened. About 150.0-200.0 blood was released from the pericardial cavity. In the area of the left ventricle there are two through wounds measuring 1.5x1 cm with jet bleeding in the form of a fountain. Bleeding heart wounds are covered with a finger and stitches are applied. Hemostasis, dry. Blood from the pleural cavity is collected for reinfusion. Blood clots were removed from the pleural cavity. When examining the lungs, there were about 5 lung injuries. The lung tissue in places in the wound area is extensively imbibed with blood. Lung wounds were sutured with continuous sutures. The chest wounds on the inside were sutured. Further inspection revealed no other damage. The pleural cavity is dried, drained into the 7th intercostal space on the left along the posterior axillary line and into the 2nd intercostal space along the midclavicular line. Wound hemostasis. Layer-by-layer sutures on the wound, bandage. Postoperative diagnosis: Multiple penetrating wounds into the pleural cavity on the left (three). Two perforating heart wounds. Cardiac tamponade. Multiple wounds to the left lung (five wounds). Hemothorax on the left. Hemorrhagic shock 3 tbsp. (clinical death).” Erbent on December 27, 2006 by ambulance to the intensive care unit of the Central City Hospital in the city of Imal, then to what degree of alcohol intoxication

Conclusions

Based on the research conducted, in accordance with the questions posed, I come to the following conclusions:

1. Analysis of expert opinion No. 50 dated December 23, 2006 – January 26, 2007 (examination of the corpse of the citizen——————.) provides the basis for the following judgments:

1.1. Forensic examination of the corpse——————. carried out by an expert———————. not in full, in particular:

1.1.1. The localization of the wound on the anterior surface of the chest on the left along the midclavicular line is indicated approximately (“at the level of 2 and 3 ribs”), which is unacceptable in forensic documentation; there is no description of the edges, ends and walls of this wound;

1.1.2. The second wound on the anterior surface of the chest on the left is localized not in relation to permanent anatomical landmarks (ribs, anatomical lines), but in relation to the postoperative wound;

1.1.3. There is no description of the edges, ends and walls of the wound at the level of the 6th rib along the anterior axillary line;

1.1.4. The exact localization (in relation to the ribs and anatomical lines of the chest) of the wound on the posterior surface of the chest on the left is not indicated, there is no description of the edges, ends and walls of this wound, the direction of its length;

1.1.5. The nature of the edges, ends and walls of the wound in the area of the left brow ridge, the direction of its length are not described;

1.1.6. The direction of the wound channel and its approximate length are indicated only for the wound on the posterior surface of the chest on the left; for the remaining stab wounds, this extremely important information is not included in the research part of the report;

1.1.7. A method for draining the left pleural area into the 2nd intercostal space along the midclavicular line has not been described;

1.1.8. The exact localization of stab injuries to the left lung and heart is not indicated, and the available description of the localization of stab injuries to the heart is contradictory; the course of the wound channels from specific skin wounds to damage to the left lung and left ventricle of the heart was not traced;

1.1.9. When describing what was found on the body ——————. abrasions and bruises do not indicate their shape, the color of the bruise in the left parietal region, the nature of the surface of the abrasion in the frontal region;

There are serious errors in the research part of the report; in particular, it is stated that during surgery, 1500-2000 ml of blood was found in the pericardial cavity (in reality - 150-200 ml).

1.2. Description of the ends of the stab wounds on the skin of the corpse——————. (where it is available), namely, both sharp ends of the wound, indicating the use of a double-edged blade, contradicts the results of a medical-forensic study of skin flaps, which established that the active blade had one blade and a spine with pronounced ribs. The expert did not explain this contradiction.

1.3. Contrary to the requirements of the Code of Criminal Procedure of the Russian Federation and Federal Law No. 73-FZ “On State Forensic Expert Activities in the Russian Federation,” the conclusions of expert report No. 50 are not substantiated in any way, they are declarative and unfounded, while the research part of the report does not contain information that could would argue the expert's conclusions about the infliction of all the injuries found on the corpse within the period specified in the resolution, about the possibility of Dzhabrailov committing S.Ya. purposeful actions after causing the entire set of injuries found on the corpse, about the relative position of the victim and the attacker.

The questions raised in the direct wording of the decision on the appointment of the examination about the sequence of damage and about the possible characteristics of the design and dimensional data of the operating piercing-cutting weapon were left unattended by the expert.

2. Answer to question 1 « Is the number of injuries on the body consistent with——————-. in the form of stab wounds discovered and indicated in the conclusion of the judicialmedical examination No. 50 dated December 28, 2006 and in a photocopy of the emergencyoperational journal of the surgical department of the Derbent Central City Hospital—————-. and do they coincide in localization? If not, then what kind of bodily injuries are not reflected in the EM report?”

In section of the expert’s conclusion No. 50 “Data from medical documents” and in the copy of the operating journal presented to the specialist, it is indicated that ———————. available three stab wounds of the left half of the chest, penetrating into the pleural cavity, while the location of these wounds is not indicated in the specified medical documents. The research part of Conclusion No. 50 describes four stab wounds of the left half of the chest penetrating into the pleural cavity - two wounds on the anterior surface of the left half of the chest along the midclavicular line, one wound of the left half of the chest along the anterior axillary line and one wound of the left half of the chest along the scapular line.

Thus, the number of stab wounds of the left half of the chest described in expert report No. 50 does not correspond to the number of wounds indicated in the medical documents (in the medical history cited by the expert and in the operating journal of the surgical department of the Derbent Central City Hospital. This contradiction in the expert report is not explained and at present can only be clarified through investigation.

3. Answer to question 2 “What is the likely sequence of infliction————————. stab wounds?

The omissions identified in the research part of expert report No. 50, in particular, the lack of tracing the course of wound channels from specific skin wounds to damage to the left lung and left ventricle of the heart, currently exclude the development of a scientifically based opinion on the sequence of infliction———————. stab wounds of the left half of the chest.

4. Answer to question 3 “Do the medical data on the location, nature and characteristics of the injuries identified during the examination of the corpse correspond to the indicationsthe accused ——————about the method of inflicting injuries that led to deathvictim?

According to the specialist, the testimony of the accused———————-. about the method of causing injuries that led to the death of the victim do not correspond to objective data on stab injuries established during the forensic medical examination of the corpse——————. and general medical laws, namely:

————-. testified that ———————began to choke him and he used the knife only when he began to choke. In accordance with the patterns of development of mechanical asphyxia, compression of the neck due to the cessation of blood outflow from the brain through the venous system and the continued flow of blood through the arteries almost instantly leads to the development of severe muscle weakness, which excludes the possibility of the victim performing active, purposeful actions.

—————. testified that he inflicted stab wounds———————. not with the desire to kill him, but “waving a knife.” With the specified———————. its relative position and———————-. due to the close contact of the front surface of their bodies, the front surface of the chest is———————. (where two stab wounds were found, one of them with damage to the heart) is inaccessible for striking with a knife blade.

——————-. showed that after causing————————. stab wounds “...his grip on my neck loosened and he walked away from me. Headed towards the beer bar...” If the victim has two stab wounds of the left ventricle of the heart of significant size (1.5x1 cm each according to medical documents), massive blood loss as a result of bleeding into the cavity of the pericardial sac (pericardium) and into the left pleural cavity leads to a sharp, rapid (within a few seconds) drop in arterial blood pressure, excluding the possibility of committing———————. after inflicting on him a complex of stab wounds, the actions described ——————Therefore, the testimony——————. do not correspond to the truth.

5. Answer to question 4 “What, at the time of the infliction of the stab wounds, is his most likely relative position in relation to the attacker?”

The localization of the stab wounds found on the corpse, described in expert report No. 50———————-., allows for many mutual positions of the victim and the attacker when each of these wounds was inflicted, while their true relative position is based on a study of the localization of the wounds , the direction of the wound channels cannot be established. The task of the situational examination appointed in such cases is to establish the correspondence of the testimony of the accused, victims or witnesses with the objective data established during the forensic medical examination of the corpse. A prerequisite for carrying out such an examination is the preliminary conduct of a series of well-conducted investigative experiments with the reproduction of the situation of the incident according to the testimony of these persons.

6. Answer to question 5 “Is the forensic expert authorized to make sole conclusions?to the questions posed, or is it necessary to conduct a commission or comprehensive examination with the involvement of specialists from another field?”

Analysis of the tasks assigned to the expert———————. in the resolution ordering a forensic medical examination of the corpse———————-. indicates that most of these issues fall within the competence of an expert with special training in forensic medical examination and the highest qualification category.

The question is about the possibility of causing the received——————-. wounds in a specific situation falls within the competence of situational examination and is resolved by specialists with special training in this type of forensic medical examination (usually specialists from the medical-forensic department of the forensic medical examination bureau.

The documents regulating the production of forensic medical examinations do not contain instructions on conducting a situational examination on a commission or individual basis; this issue can be resolved by the investigator when ordering an examination or by the head of the expert institution when accepting the examination for production.

Specialist _______________S. Zosimov

If a weapon has a sharp end and a sharp edge, their simultaneous action leaves damage called stab wounds (Fig. 6.9, 6.10). Tools that cause stabbing injuries are called piercing tools. The most common type of piercing and cutting implements is knives. Daggers are also piercing-cutting; they have one point and two blades.

Let us consider the mechanism of damage to the human body using the example of the action of knives with a one-sided sharpening of the blade.

The nature of damage resulting from the action of the blade is influenced by the features of its structure. One of the typical representatives of knives is the so-called Finnish knife (Fig. 6.11). The knife has the following parts: blade and handle; The sharp edge of the blade is called the blade. The sharpened edge may extend directly to the handle, but more often it ends at a heel or beard. The blunt edge of the blade is called the butt or back. The back of the knives can have a different cross-section - from round to diamond-shaped. It can be straight to the very tip or beveled. The place where the blade and the back meet is called the point. On the side surfaces of the knives there may be valleys - machined grooves along

Rice. 6.9.

Rice. 6.10.

Rice. 6.11.

1 - blade; 2 - handle; 3 - blade; 4 - sharpening the blade; 5 - base of the blade (bit); b - tip; 7 - butt bevel; 8 - sharpening the butt bevel; 9 - butt; 10 - undercut; 11 - ring;
12 - handle; 13 - tip

blade. There is a stop-limiter between the blade and the handle. When describing knives, blades are distinguished between the right and left side surfaces. They are determined by placing the knife with the handle towards you and the blade down.

When the knife blade is immersed in the tissue of the body, the tissue is simultaneously pushed apart by the tip and cut by the action of the blade (Fig. 6.12). A stab wound is formed, which is characterized in most cases by a relatively short length, smooth edges, and significant depth (wound channel). The ends of the wound when sharpening the blade on one side are different: one is sharp; the other can be rectangular, rounded or diamond-shaped, depending on the shape of the butt part of the knife and the nature of the stretching (gaping) of the wound. Stretching of the wound - the divergence of its edges depends not on the thickness of the damaging blade, but on the location of the cut elastic fibers of the skin relative to the length of the wound. When the fibers cross transversely, the edges of the wound are moved apart as much as possible, but if the length of the wound and the direction of the fibers coincide, then its edges will be moved apart slightly.

The immersion and removal of the blade when causing damage with a knife does not occur strictly in the same direction, i.e. the blade is immersed in the victim’s body in one position, and removed with some rotation. In this case, a so-called main incision is formed in the wound (when the blade is immersed) and an additional one (when it is removed). Identification of the main and additional cuts is important, since along the length of the main cut the moment of immersion of the blade is possible

The moment of removing the blade from the wound

Rice. 6.12.

but set the width of the blade at the level of its immersion in the victim’s body.

The depth of the wound channel in case of damage to the chest characterizes the length of the blade. If the blade is completely immersed in the body, then based on the depth of the wound canal, forensic doctors can fairly accurately estimate the length of the blade. In case of wounds in the area of the anterior abdominal wall, the depth of the wound channel may exceed the length of the blade by several centimeters due to the significant mobility of the abdominal wall.

Sometimes the piercing-cutting instrument of injury remains in the wound canal and then the task of forensic doctors is to fix its position verbally and by other methods. It is better to remove the weapon from the wound canal in the morgue in

barely a detailed study of its position.

When the knife is completely immersed in the human body, the limiter may be displayed in the form of an abrasion of one form or another in the area of one or both ends of the wound (Fig. 6.13).

Characteristics of the wound, wound channel, traces of application along the edges of the wound are valuable information for determining the characteristics of the knife used

n G^ bathroom in quality. 6. 13. Mechanism of formation

„ v ve tools of grass-

stab wounds and abrasions f {

v v We. In the presence of

from the knife stop

supposed

instruments of injury, forensic scientists can conduct a comparative study of experimental wounds caused by such an instrument and wounds existing on the victim’s body. If the damage contains a set of signs that reflect the individuality of the instrument of injury, it is possible to identify the knife by the damage it left behind.

Traces of their interaction remain on the body of the victim exposed to a piercing-cutting weapon and on the instrument itself. A comprehensive study of traces of the mutual reflection of the blade and the tissues of the human body using modern research methods, as a rule, provides the basis for a reliable conclusion that the injuries on the victim’s body were caused by this particular instrument of injury.

Great opportunities for individual identification come from traces of the microrelief of the blade,

remaining on cartilage and bone tissue when damaged by knives. Such traces, with their traceological comparative study, make it possible to reliably identify a piercing-cutting instrument of injury.

The nature and number of stab wounds, the direction of the wound channels, the relative position of several injuries and other data, in particular the characteristics of damage to clothing, make it possible to characterize in sufficient detail the mechanism of causing the entire set of injuries on the body of a murder victim, which makes it possible to characterize the event to one degree or another crimes.

If there are versions of the prosecution or defense for multiple injuries, they can be confirmed or refuted quite clearly. It is good to organize this kind of work in several stages. At the first stage, the injuries on the corpse are thoroughly examined. 11a second - an investigative experiment is carried out, during which the accused reproduces his criminal actions. At the third stage, the forensic expert compares the data obtained in the first two stages and makes a conclusion about the correspondence or non-compliance of the testimony of the accused with the data established on the corpse. Forensic physicians illustrate this kind of expert research with diagrams, photographs and other visual materials.

Based on the location of the stab injuries, their number and nature, in most cases a forensic physician can help the investigator resolve the issue of the possibility of self-infliction of these injuries.

Forensic medicine: a textbook for honey. universities / V. II. Kryukov [and others]. M.: Medicine, 1990.