Department of consumer and business services, workers compensation division. Background Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and. IL9/9780387955599.jpg' alt='Manual Of Surgical Pathology Gross Room Procedures Manual' title='Manual Of Surgical Pathology Gross Room Procedures Manual' />A firearm may be generally defined as an assembly of a barrel and action from which a projectile is propelled through the deflagration rapid burning of a. Overview, Modern Small Arms, Epidemiology. Various types of firearms may produce wounds that have different characteristics reflective of the type of weapon inflicting the injury. However, many characteristics of firearm wounds are similar across the range of weapons. We will first discuss these basic characteristics, which are, in general, associated with handgun wounds. For a much more detailed treatment of this topic, the reader is referred to the classic textbook on the subject by Di. Maio. 2 Entrance wounds. Firearm entrance wounds are typically round to oval, with smooth edges and a zone of epidermal abrasion surrounding the wound edge. This abrasion is caused by the rubbing or scraping of surrounding skin surfaces by the bullet as it indents the skin before perforating it. If the bullet strikes perpendicular to the skin, the abrasion will be of uniform width around the wound, as seen in the image below. If the bullet strikes the skin at an angle other than perpendicular, the abrasion will be widest along the margin from whence the bullet came toward the muzzle of the firearm. See the following images. It must be kept in mind that the distinction of entrance versus exit wounds is not always a simple matter. With the exception of contact and intermediate range wounds, no single feature of a firearm wound of entrance eg, shape, abrasion, size is necessarily diagnostic of an entrance wound. Rather, the totality of the wound features should be considered to differentiate between entrance and exit wounds. It should also be noted that caliber of an impacting projectile cannot be reliably determined from the size of an entrance wound on the skin. Distantindeterminate wounds. If the muzzle of the firearm is more than a few feet from the skin, there will be no residues of any kind deposited on the body surrounding the firearm wound. This type of wound is classified as a distant wound. D reconstruction of the pathological volume and image coregistration Head and neck Pathology processing. Studies involving laryngectomy specimens have been. Compendium of all course descriptions for courses available at Reynolds Community College. Some practitioners refer to these as indeterminate wounds, based on the concept that one cannot entirely rule out the possibility that the wound was produced by firing at close range through an intermediate target that screened the firearm residues from the skin. This should, of course, be considered as a possibility during examination of death scenes and the body of a firearm wound victim. Hard contact wounds, stellate wounds, and muzzle imprints. The discharge of copious amounts of hot gas, soot, unburned, or partially burned powder particles, metallic fragments, or other debris from the muzzle of a firearm, along with the bullet may result in characteristic findings on the skin or clothing of a firearm wound victim. When the muzzle of a firearm is held firmly against the skin of a victim as it is fired, a hard contact wound results. In this wound, a dark zone of soot carbon deposition is present around the edge of the entrance wound, as shown in the image below. This soot is seared into the skin by hot gases exiting the firearm muzzle and cannot be completely washed away from the wound. It may also be possible to discern a cherry red color of the underlying soft tissues due to the carboxyhemoglobin formed when carbon monoxide that is formed from the burning powder charge is injected into the tissues with the muzzle blast. If the muzzle of a firearm is held firmly against the skin overlying a flat bony surface, such as the skull, a stellate wound may result. This irregular wound may be quite large and results from gases expelled from the firearm dissecting beneath the skin of the wound, with resultant explosive rupture of the skin as the gas expands. Although such a large and irregular wound is often misinterpreted by untrained individuals as an exit wound, the large quantities of soot often present within the wound and on the underlying skull should be a clue to its true nature see the following image. The same process of gas expansion beneath the skin may result in a muzzle imprint. In a contact firearm wound, gas may dissect beneath the skin and cause it to expand or balloon outward, forcibly impacting the muzzle of the impinging firearm. This results in an impact abrasion that may partially or fully replicate the configuration of the firearm muzzle see the first image below. Adobe Cs3 Master Collection How here. The actual wound defect may also have a stellate appearance if it is over the skull see the second image below. Another contact firearm wound phenomenon results in a radial strip of soot and seared skin that extends from the edge of a firearm wound. Various explanations for the phenomenon have been offered, but it may result when, after the bullet enters the body, the muzzle of the gun slides across the skin for a brief instant as hot gas and soot continue to issue from the muzzle. This may result in painting a strip of soot andor searing radially from the wound see the following image. Another explanation for this phenomenon of a radial strip of soot and radially extending seared skin is that it represents an incomplete contact wound, resulting from a partial break in contact between the muzzle of the firearm and the skin, allowing a jet of hot gas to extend outward from the wound. However, in most wounds, the area of soot deposition and burning might be expected to be fan shaped as opposed to bandlike. This process appears to be particularly common with. Muzzle compensators or muzzle brakes may also produce characteristic findings on the skin around a wound. These are devices on the muzzle of a firearm that direct gas upward and perpendicularly usually from the barrel of the gun to help limit muzzle rise and attenuate recoil. Such a compensator may consist of 2 slots milled into the barrel andor slide of a pistol or other firearm, allowing gas to issue in a radial fashion from each side of the upper edge of the muzzle end of the firearm on firing. This may result in marking with searing andor soot deposition the skin around the wound in a V shape. Similar marks may be seen from flash suppressors on rifle or shotgun barrels. In the case of flash suppressors, the radial burns may extend from multiple points around the wound, depending on the type of suppressor installed. See the images below. Loosenear contact wounds. When the barrel of a firearm is held in loose contact with the skin or up to a few centimeters away, soot may be deposited loosely on the skin see the following image. The soot from this loose contact or near contact wound is not seared in place like that of a hard contact wound, and it may be largely washed away during cleaning of blood from the wound. Consequently, examination and photographic documentation should take place before cleaning. Once this has been done, gentle cleaning of the wound with warm water and very light scrubbing may serve to remove obscuring blood while leaving the majority of the soot on the skin. In either case, the overall pattern of soot distribution and its area should be documented. Keep in mind that some modern ammunition is quite clean, with much less soot and powder deposition than might be expected. Bullet wipe. Take care not confuse soot surrounding a close contact or intermediate range firearm wound with bullet wipe. As a bullet passes though the barrel of a firearm, it picks up a coating of powder, soot, lead, dirt, oil, or any other material soiling the bore of the gun. Batalha Espiritual Pdf'>Batalha Espiritual Pdf.