Incised wound healing, second intention and wounds caused by glass
THE CONTEXT
The passage gives a sequence for uncomplicated incised wound healing, describes the greater scarring of second-intention healing, and explains why glass wounds can resemble sharp-force injuries.
Early wound changes
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A fresh incised wound shows haematoma formation. At 12 hours, the edges are red, swollen and adherent with blood and lymph, with leucocytic infiltration.
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Within minutes, histology shows capillary dilatation, neutrophil margination and emigration, reactive changes in tissue histiocytes and swelling of vascular endothelium.
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Fibroblasts show reactive changes within a few hours. At 12 hours, monocytes appear in the exudate and leucocytic infiltration is appreciable; at 15 hours, monocytes begin mitotic division.
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At 24 hours, epithelium begins growing at the edges and vascular buds begin forming. The gross description also records a surface-covering cell layer with an overlying crust or scab of dried clot.
Later healing and scar formation
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At 72 hours, macrophages largely replace neutrophils and vascularised granulation tissue forms.
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At 4–5 days, new fibrils form and continuing epithelial proliferation produces a thickened layer. Small wounds develop a soft, reddish scar at one week.
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Infection considerably modifies the described healing changes.
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Healing by second intention involves more intense inflammation and much larger amounts of granulation tissue, producing a greater mass of scar tissue.
Wounds produced by glass
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Glass wounds are lacerated but may resemble incised or stab wounds. A sharp-pointed piece entering by its point produces a stab-like appearance.
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Irregularities of glass almost always produce tiny side cuts at the margins, and glass particles may remain in the wound.
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Assault with broken glasses or bottles produces multiple irregular incised-type wounds of variable depth and severity.
Medicolegal interpretation
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Incised wounds indicate a sharp-edged weapon and may permit assessment of injury age and direction of force.
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Wound position and character may indicate suicide, accident or homicide.