Interleukin 1 beta and Interleukin 6 Estimation as Parameter of Timing of Injury in Lacerated Skin Wounds with Morph- pathological Features in Homo sapiens: a Postmortem Study
Timing the age of a wound is a challenge in forensic pathology and can contribute to the reconstruction of crime scenes and lead to the arrest of a suspect 1–3 Forensic pathologists must identify the timing and order of injuries in cases involving multiple traumas by different offenders because punishment typically varies according to the severity of the injury. After in?iction of a wound, a series of vital reactions (e.g. haemorrhage, in?ammatory cell in?ltration, formation of granulation tissue) must be taken into consideration to obtain convincing proof of ante-mortem injury. These ante-mortem reactions are collectively termed “vitality”, which is related to whether the victim was alive at the time of the trauma and how long before the death of the victim the trauma was
Laceration is defined as tearing of the skin that result in an irregular wound, may be caused by injury with a sharp object or by impact injury from a blunt object or force. Lacerations may occur anywhere on the body. In majority of cases, the tissue injury is minimal and infections also, However, severe lacerations may extend through the full thickness of the skin and into subcutaneous tissues including underlying muscles, internal organs and bones. Severe lacerations often are accompanied by significant pain and bleeding.
In violent death, the main focus is on whether an injury was caused while the individual was alive or during the agonal or postmortem period and time lapse that victim survived after the wound was in?icted 4.
Because of the uncertain and variable results of the naked eye examination of the wounds, it is important to study the injuries microscopically (morpho-pathological study). The value of significance of histopathological study can be considered from different aspects: first, according to evidential value of tissue data itself as they can easily be preserved as a piece of evidence that can be provided in the court of law if and when required. Second, according to its position, which result from the facts of the case that have come to light in combination with other findings.Third, the cellular changes in the tissues can be observed over a longer duration and postmortem changes take some time to significantly affect the assessment.
To establish the causal relationship between times of infliction to the time of death, the age of the wound has to be determined more accurately and objectively for it to be medico legally important. It is highly significant to precisely date the injury even in clinical forensic medicine. The forensic medical examination of wound for determination of age is also being defendable in the court.
The dynamics of wound healing are complex. A deep understanding of the normal healing process is a crucial for unveiling the pathology. Wound healing begins with blood cloting (homeostasis) at the site of injury with progressing to inflammatory phase and finally by proliferation of the epithelial and matrix components with the formation of scar tissue marked by laying down of a highly organized collagen matrix and various factors, extrinsic and intrinsic to the injured tissue, affect the healing process.
Factors affecting wounds healing
• Local factors: Foreign body.oxygenation and blood supply
• Systemic factors: Age, gender,
diseases like diabetes, keloids, fibrosis, jaundice, uremia,
medications like non-steroidal anti-inflammatory drugs, glucocorticoids, chemotherapy Stress, nutrition, alcoholism
Immunocompromised status, like acquired immune-deficiency state, cancer, radiation.
The wound healing process consists of four phases: hemostasis (coagulation and hemostasis with platelets activation and cytokine release), inflammation, proliferation (re-epithelialization) and remodeling (granulation tissue, angiogenesis, and matrix production and scar formation with remodeling).
Wound healing is a complex process in which the skin and the supporting tissues lies under it, repair themselves after insult or injury.(1) Intact undamaged skin composed of the epidermis (surface layer) and dermis (deeper layer) form a protective barrier against the external environment. When the barrier is broken, a regulated sequence of biochemical events is set into motion to repair the damage. (1)(2) This process is divided into well recognized phases: blood clotting (hemostasis) and inflammation, tissue growth (proliferation), and tissue remodeling (maturation). Blood clotting is considered a part of the inflammation stage instead of a separate stage. (3)
• Hemostasis or blood clotting: Within the first few minutes of injury, platelets in the blood begin to stick to the injured site. Activated platelets change into an amorphous shape, more suitable for clotting, and release chemical signals to promote clotting. This results in the activation of fibrin forming a mesh and acts as (glue) to bind