The Case: A 24-year-old male presents to the emergency department sustaining the wound shown in Figure 1 from a broken beer bottle. He states that someone broke the bottle and cut him with it. What is the correct discharge diagnosis for the chart?

Answer: Incised wound or cut.

Discussion

Although emergency medicine providers commonly describe any break in the skin as a laceration, this terminology is forensically and technically incorrect. A laceration is defined as a tear in tissue caused by a shearing or crushing force.^1,2 Therefore, a laceration is the result of a blunt-trauma mechanism. A laceration is further characterized by incomplete separation of stronger tissue elements, such as blood vessels and nerves. These stronger tissue elements account for “tissue bridging” which is seen in lacerations (see Figure 2). In addition, lacerations commonly occur over bony prominences and tend to be irregularly shaped with abraded or contused margins. Lacerations are typically caused by hard objects like a pipe, rock, or the ground. The crushing mechanism may have an effect on wound healing and scarring and increased risk of infection from the devitalized tissue.

A cut or incised wound is produced by a sharp edge and is usually longer than it is deep (see Figure 3).^1,2 Because of the sharp-force mechanism of injury, incised wounds lack tissue bridging and often display very clean, sharp wound edges. Knives, box cutters, glass, and metal typically cause incised wounds. In contrast, stab wounds are sharp-force injuries produced by a pointed instrument where the depth of the wound is greater than the length of the wound on the skin. Once again, there is no tissue bridging.

Figure 1. Wound from a broken beer bottle. Figure 2. Laceration (caused by blunt force trauma), mimicking a sharp force injury. The presence of “tissue bridging” (arrows) helps to differentiate a laceration from a sharp injury. Figure 3. An incised wound of the face. Note that the wound is longer on the skin surface than it is deep.

An easy way to remember the difference is to think of a glass beer bottle. If someone takes the bottle and smashes it over someone’s head and the skin is opened, that is a laceration. If a person breaks the bottle on a table and uses the piece to slash someone, it is an incised wound.

References

1. DiMaio DJ, DiMaio VJM. Forensic Pathology. 2nd ed. Boca Raton, Florida. CRC Press, LLC; 2001.
2. Forensic Medicine for Medical Students. Lacerations. Available at: www.forensicmed.co.uk/wounds/blunt-force-trauma/lacerations. Accessed July 21, 2014.

Dr. Rozzi is an emergency physician, director of the DOVE program, and vice chair of the forensic section at WellSpan York Hospital in York, Pennsylvania.