Practice
10-Minute Consultation
Minor incised traumatic laceration
Cite this as:
BMJ
2012;345:e6824
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25 January 2013
We would very much like to thank all the responders for their comments and correction on the terms ‘laceration’ and ‘incision’. We agree that the meaning of the terms may have partially been ‘lost in translation’. The patient we originally chose to describe, did in fact have a ‘laceration’. However, during the reviewing process it was suggested to change the case and the term was not changed accordingly.
Furthermore, in the Netherlands the described terms are often mixed up, without consequences for wound management or legal cases. In the Netherlands, suspicious wounds related to trauma are usually judged by a forensic doctor who is specifically trained. Yet again, we fully agree that the use of correct medical terminology is important and we thank all colleagues for responding to our paper.
Best wishes,
Eefje GPM de Bont and Jochen WL Cals
Competing interests: None declared
Maastricht University, CAPHRI, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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21 January 2013
It is disheartening to see that the use of the correct terminology for wounds and injuries still eludes the medical profession, and this journal (Milroy and Rutty 1997, Irvine 2002).
Cals and de Bont (2013), in their 10-Minute Consultation, describe the injury sustained by the 40 year old man as a laceration (i.e. a tearing or splitting of the skin caused by blunt force trauma), and yet they state that the injury is ‘incised’, and was caused by a knife (i.e. it is caused by sharp force trauma).
I would not regard it as unreasonable to suggest that all qualifying doctors ought to be able to describe the characteristics of wounds and injuries, using the correct medicolegal terminology, and be able to determine the most likely mechanism involved in their causation.
All final year medical undergraduate students at Cardiff University School of Medicine receive lectures covering the pathology of trauma, including wound and injury interpretation, and an optional Student Selected Component (SSC) can be taken by second year students, in which practical wound and injury classification and interpretation is incorporated into a 5 day experiential learning opportunity. This teaching and learning also explores the interpretation of patterns of blunt and sharp force injury, and a consideration of whether wounds and injuries might have been inflicted by another person.
I would be delighted to hear from other interested medical educators on how best to incorporate simple, yet essential, teaching and learning of wounds and injuries into undergraduate medicolegal curricula.
References
Milroy CM, Rutty GN. If a wound is “neatly incised”, it is not a laceration. BMJ 1997;315:1312
Irvine AJ. Incisions are not lacerations. BMJ 2002;325:1113-1114
Cals JWL, de Bont EGPM. 10-Minute Consultation: Minor incised traumatic laceration. BMJ 2013;346:38-39 (e6824)
Competing interests: None declared
Wales Institute of Forensic Medicine, University Hospital of Wales, Heath Park, Cardiff, Wales, CF14 4XN
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21 January 2013
This excellent article unfortunately fell into the common trap of confusing what the terms laceration, incision and wound mean precisely. This may seem to be a minor error but it can have legal implications. A laceration by definition is caused by a tearing force, not a cutting one. An incision is caused by a sharp object, such as a knife. A wound is a generic term which encompasses both lacerations and incisions. Lacerations therefore cannot be caused by knives. This is of particular importance in cases of assault with a knife. If wounds are documented as lacerations then they cannot have been caused by the knife and this can be used as a line of defence. It is better to avoid any confusion and describe all injuries where there is a break in the skin as wounds. This term does not imply a mechanism of injury and is unambiguous.
Competing interests: None declared
Imperial College Healthcare NHS Trust, London W6 8RF
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21 January 2013
The three rapid responders are, of course, right in so far as
BRITISH teaching is concerned. However, I see that the (Dutch) authors have cited as one of the references, an article by Singer, Hollander and Quinn, who are American and whose article was published in the New England Journal of Medicine. Shoot, if you must, the New Englanders who do not follow the glorious traditions of Ye Olde England, but spare my innocent friends across the Channel.
JK Anand
(Of course I learnt Forensic Medicine in English English)
Competing interests: None declared
Free spirit, 3 Wayford Close,Peterborough
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30 October 2012
Excellent article, but for one quibble - although the article acknowledges that it isn't always easy to tell the difference between a laceration and an incised wound, I believe that the title is unfortunately misleading. The described injury would seem to most probably be an incised wound (that is, a wound defect due to a cutting action, or contact with a sharp surface) and NOT a laceration (that is, the tearing of a surface due to the effects of blunt force contact).
Competing interests: None declared
QHFSS, Cairns Queensland Australia
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