Volume 03 Issue 04-2023
112
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
112-115
SJIF
I
MPACT
FACTOR
(2021:
5.
694
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(2022:
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893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
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Servi
ABSTRACT
Blunt mechanical trauma is one of the main medical and social problems of our time. The beginning of the third
millennium is characterized by the intensification of people's lives, the need for rapid movement, the development of
transport and technology. This inevitably has its downside in the form of an increase in the risk of injuries in transport
and in everyday life, which is greatly facilitated by widespread urbanization. Therefore, the death rate from blunt
mechanical trauma remains one of the leading places in the overall structure of the mortality of the world's population
[1].
KEYWORDS
Blunt mechanical trauma, discussion.
INTRODUCTION
For forensic medicine, this means the increasing
importance of studying the lifetime and age of injuries,
including soft tissues, which are the first to encounter
traumatic agents.
It is their injuries that carry information about the time
of injury. Thus, blunt mechanical trauma is a significant
socio-economic problem, the development of which
requires forensic experts to apply efforts in this
matter. [3,].
The early period after the injury, when the survival of
cells and tissues is preserved, is still the most difficult
and most subjective in the expert interpretation of the
prescription of injuries.
Research Article
FORENSIC MEDICAL ASSESSMENT OF THE PRESCRIPTION OF SOFT
TISSUE INJURIES IN THE PRACTICE OF EXAMINATION
Submission Date:
April 20, 2023,
Accepted Date:
April 25, 2023,
Published Date:
April 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue04-17
Ibragimov B. I.
Andijan State Medical Institute, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
SH. I. Ruziev
Andijan State Medical Institute, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
113
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
112-115
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
It is quite well studied by the biochemical method [4],
but in the daily expert work, the biochemical method
has not found wide application, remaining purely
scientific.
The purpose of the study. Development of an
algorithm for modern morphometric assessment of
the prescription of soft tissue injuries in the practice of
forensic medical examination.
Material and methods of research. To study the
prevalence of soft tissue injuries in blunt mechanical
trauma, we used archival data, clinical and sectional
materials collected on the basis of the thanatology
departments of the Tashkent City branch of the
Republican Scientific and Practical Center for Forensic
Medical
Examination.
For
morphometric
and
histological studies, pieces of soft tissues of the limbs
and trunk (skin, subcutaneous tissue, subcutaneous
muscles) of people who died from traumatic and non-
traumatic causes of death were collected.
The study was based on data from the analysis of 53
cases of soft tissue injury with a blunt object at the age
of 18 to 37 years. The greatest number of soft tissue
injuries was registered among men (57,8%).
The largest number of injuries are domestic-27 (50,9%)
cases, the second most common in street injuries - 11
(20,7 %), of which 3,7% are transport injuries, as well as
school and sports injuries (13,8% and 10,9%,
respectively).
Overall, it was found that men were 2,2 times more
likely to be injured than women.
The structure of injuries of men and women in general
did not differ, the leading injury was hard blunt objects
(household), and in men it was 1,5 times more common
than in women. The second place in the structure of
injuries was occupied by street injuries, and their
frequency in men was 1,9 times higher than in women.
The data analysis was carried out taking into account
the criteria of the severity of injuries in accordance with
the articles of the Criminal Code of the Republic of
Uzbekistan (Articles 104, 105 and 109) and the Order of
the Ministry of Health of the Republic of Uzbekistan
No. 153 of June 01, 2012.
The results of the study and their discussion.
As a result of histological examination of injured soft
tissues in dynamics, we found that it makes sense to
adhere to the division of tissues into two zones - the
zone of destruction and the zone of reactive changes.
At death at the accident sites, we saw areas of tissue
destruction in the destruction zone, while the
destruction zones were heterogeneous - destroyed
tissues in the form of tissue detritus and fragments,
fragments of muscle and connective tissue fibers,
adipose tissue cells, fragments of the epidermis were
located among islands of unchanged soft tissues.
Often, the destruction zones were clearly localized -
abrasions, bruises - in these cases, violations of the
integrity of the epidermis, its marginal flattening and
compaction (abrasions), hemorrhages in the tissues
that erased the pattern of the structure of the tissues
were clearly visible.
Hemorrhages in the areas of destruction were not
always present
—
in 23,2% of cases they were absent.
In the existing hemorrhages, red blood cells were not
always changed (leaching, hemolysis), there were
often foreign impurities - soil particles, clothing fibers,
unidentified particles. Sometimes there was a weak -
from individual cells-admixture of white blood cells.
The destruction zones occupied almost the entire area
in the sections, up to 77,8%, but islands of preserved
Volume 03 Issue 04-2023
114
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
112-115
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
soft tissues were clearly visible around the destruction
zones and their thickness.
We did not find any pronounced changes in the color
of the dermis, the fibers of the striated muscles-
metachromasia-although there were still weakly
pronounced changes in the color of the dermis.
Already in this time period, we can talk about the
pronounced fragmentation of striated muscle fibers
and their dystrophic (degenerative) changes.
Degenerative changes, which are manifested in the
disappearance of nuclei, swelling and metachromasia
of fibers, are barely traced. The vessels of the tissues in
this time interval are empty, sharply and unevenly
expanded. In some sections, single full-blooded
capillaries of the stroma of soft tissues are visible.
Sometimes in the destruction zone, the stroma of the
tissues is not visible due to the destruction of the soft
tissues. The cells of the fat injured tissue had different
shapes, sometimes irregular, ugly.
In the zone of reactive changes, we noted the
preservation of the structure of tissues - skin,
subcutaneous tissue, and muscles-at the scene of
death. In the skin there were overlays on the preserved
epidermis - blood, soil particles, clothing fibers,
structureless masses. Often, the stratum corneum of
the epidermis was absent, while the remaining layers
were preserved. There was no metochromasia in the
dermis, but there was a slight loosening of the stroma.
The skin derivatives remained unchanged.
The vessels of the stroma of the dermis, subcutaneous
tissue, and muscles were empty, sharply and unevenly
dilated, with the predominance of dormant, dystonic
vessels and the fullness of single capillaries. When
studying isolated preparations of adipose tissue and
striated muscle fibers, single full-blooded capillaries of
the stroma are visible in anemia and dystonia of other
vessels, while it was sometimes difficult to reliably
speak about the belonging of the microcirculation
vessel to any channel. The cells of subcutaneous
adipose tissue and adipose tissue around the
destruction zone remained inactive throughout all the
studies
—
no changes in their shape or size were
noted. The stroma of adipose tissue and muscle fibers
was swollen. The fragmentation of striated muscle
fibers was weak, capturing individual fibers or bundles
of fibers, or absent. At the same time, the phenomena
of fiber swelling, cytoplasmic basophilia, weak nuclear
distinctness, and transverse striation are seen in many
myocytes.
After 2 hours, the destruction zone already occupied
the entire section, but small islands of soft tissue were
also
discernible,
retaining
their
structure.
Hemorrhages in the zone of destruction became
denser, the pattern of the structure of tissues was
completely erased in their thickness, the degree of
hemolysis of red blood cells and the number of white
blood cells increased. In the areas of epidermis
sedimentation, the pycnosis of the nuclei of
compacted and flattened cells increased. The
metachromasia of the dermis was clearly visible.
The adipose cells retained their altered forms. At this
stage, the stroma of the sebaceous, sweat glands, hair
follicles, and nerve nodes becomes discernible. In our
material, there were only a few nerve nodes (up to 15),
but the changes that occurred after two hours in them
persisted over time. We believe that for a more
accurate determination of changes in the nervous
tissue of soft tissues, a separate study with a wide
application of additional colors is necessary.
Striated muscle fibers completely lost their transverse
striation, the nuclei were not visible. The vessels -
Volume 03 Issue 04-2023
115
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
112-115
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
venules, arterioles-were mostly dilated, empty. The
fullness of single dilated capillaries was preserved.
In the zone of reactive changes, after 2 hours, full-
blooded dilated vessels were noted, the structure of
the tissues was not disturbed. At the same time, the
loosening of the layers of the epidermis, edema of the
dermis stroma, muscle stroma and fiber were clearly
visible. Numerous dilated empty vessels of the venous
and arterial channels are visible. There were no other
significant changes in the reactive change zone.
After 4 hours, the destruction zone becomes more
clearly visible. The number of white blood cells in
hemorrhages increases, but remains moderate. Also,
the degree of hemolysis of red blood cells increases,
red blood cells with erased contours are visible. Fibrin
filaments appear. The destroyed tissues
—
muscle
fibers, connective tissue and adipose tissue-retain only
the contours, the cellular structure is completely
erased. Metachromasia of the dermis is even more
pronounced in the areas of sedimentation. As before,
the sebaceous, sweat glands, and hair follicles remain
inert - having acquired pycnosis of the nuclei and weak
basophilia of the cytoplasm in the first 2 hours, they
remain so during further investigation. Preserved
vessels are dilated; full-blooded venules, capillaries,
arterioles, and larger venous, arterial vessels.
Conclusion. Assessment of the age of soft tissue
damage by morphometric method in the first day after
the injury shows a reliable dynamics of the increase in
capillary anemia, increase in capillary lumen, increase in
the size of adipose tissue cells, which can serve as new
criteria for histological determination of the age of
damage.
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