Stab wounds are caused by sharp or pointed implements and wounds with a depth greater than their width or length. They are usually caused by knives but can also be inflicted with screwdrivers, pokers, scissors, etc. Although the external injury may not appear to be particularly serious, damage to vital structures, such as the heart, liver, or major blood vessels, can lead to considerable morbidity and death, usually from hemorrhage. In those individuals who survive, it is common for little information to be present about the forensic description of the wound because the priority of resuscitation may mean that no record is made. If operative intervention is undertaken, the forensic significance of a wound may be obliterated by suturing it or using the wound as the entry for an exploratory operation. In such cases, it is appropriate to attempt to get a forensic physician to assess the wound in theatre or subsequently.
Stab wounds are rarely accidental and occasionally suicidal, but usually their infliction is a result of criminal intent. In the case of suicide, the wounds are usually located on the front of the chest or upper abdomen and, as with self-inflicted incisions, may be associated with several superficial tentative puncture wounds (see Subheading 3.6.). When deliberately inflicted by an assailant, stab wounds may be associated with defense injuries to the arms and hands.
The appearance of the skin wound will vary depending on the weapon used and can easily be distorted by movement of the surrounding skin. Typi-
cally, when inflicted with a knife, the wound is usually elliptical because the natural elasticity of the skin causes its length to shrink. If the blade is double-edged, such as that of a dagger, the extremities of the wound tend to be equally pointed. A stab wound from a single-edged blade, such as a kitchen knife, will usually have one extremity rounded, squared-off, or fish-tailed (caused by the noncutting back of the blade). When blunt weapons are used—a pair of scissors, for example—the wound tends to be more rounded or oval, with bruising of its margins (see Fig. 8). Scissor wounds can sometimes have a cross-shape caused by the blade screws or rivets. Notched wounds are often caused by the blade of the weapon being partially withdrawn and then rein-troduced into the wound or twisted during penetration.
It is rarely possible from an inspection of the skin wound alone to comment usefully on the width of the blade because the skin retracts and the knife is unlikely to have been introduced and removed perfectly perpendicularly. Surprisingly, long skin wounds may be caused with quite narrow-width blades.
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