How is the wound / trauma patomechanism from the scenario?

Trauma is the leading cause of morbidity and mortality in patients under

35-years of age and the sixth leading cause of death worldwide. The majority of
serious traumatic injuries are due to blunt trauma from motor vehicle crashes and
pedestrian injuries. Falls are also an important cause, particularly in the elderly.
Direct blows, assaults, and sporting injuries are also common. Non-accidental
trauma is an important cause and should be suspected with certain presentations
and injury patterns. Blunt impact to the body may result in a variety of injuries.
Severity is related to both the mechanism of injury as well as the underlying
comorbidities of the patient. Blunt impact injuries generally can be classified into
four categories: contusion, abrasion, laceration, and fracture. Blunt impact injuries
are commonly seen in forensic autopsy practice, and appropriate interpretation of
wounds is essential for accurate medicolegal testimony.

Blunt impact injuries result from direct contact of a blunt object with a
body. A contusion results from the blunt impact of significant force to rupture
capillaries underneath the skin surface while leaving the skin surface intact, while
an abrasion results from scraping off of the superficial epidermis. Contusions and
abrasions may show distinct patterns which can be used to match a specific wound
to a potential weapon or implement; for example, a contusion over the forehead
with multiple parallel, zig-zag lines may be matched to the sole of a shoe collected
at the crime scene. A laceration results from the blunt impact of significant force
to tear the skin, leaving strands of subcutaneous tissues bridging the wound.
Contusions and lacerations may also be present on internal organs. Blunt impact
of significant force to a bone results in a fracture.

Blunt impact injuries are commonly seen in living and deceased patients.
The appearance of wounds depends on multiple factors, including the force,
speed, length of time of impact, surface area of contact, and elasticity of tissues
impacted. A large, crushing force applied to a sizable area over several minutes
will result in vast tissue damage; for example, failure of the integrity of a retaining
wall at a construction site will likely cause significant blunt impact injury if the
wall collapses on and traps the legs of an individual. Alternatively, a smaller force
applied to a smaller area will result in less tissue damage; for example, the impact
of a thrown baseball to the shoulder of an individual will likely cause minor blunt
trauma.

Blunt trauma may result in internal or external hemorrhage depending on

location and mechanism. Recent contusions are typically red/purple and go
through a series of color changes as they heal. In general, a red/purple contusion
will be more recent than a yellow/green contusion on the same patient. Similarly,
recent abrasions and lacerations are typically red/purple and heal through the
process of scab formation which imparts a tan/brown, crusted appearance to the
wound. Postmortem abrasions will demonstrate a more tan/yellow, parchment-
paper-like appearance indicating the absence of blood flow at the time the injury
occurred. Fractures heal through the process of callus formation and bony
remodeling, features which can be examined microscopically to estimate the
approximate age of the fracture and time since the injury.

A bruise (echymosis) is a collection of blood beneath the skin, resulting

from extravasations of blood from surrounding vessels, without breaking the
epidermis layer of skin. Physical injury to a blood vessel normally triggers a
vigorous physiologic response. Damage to endothelial tissue causes activation and
adhesion of circulating platelets. This in turn results in the rapid formation of
platelet plug at the site of injury, causing mark on the skin below. It takes two
weeks till months for a bruise to fade. Start off as a redish color, and then turn
bluish-purple and greenish-yellow before returning to normal.

Gambar 1Pathogenesis of bruise

 Gambar 2Colour changes of bruise
In scenario that occur in the victim is a bruise on the limbs and also
abrasions in the victim's vagina. Bruises on the victim's body caused by
the presence of blunt object with the patient's body causing the rupture of
blood vessels without damaging the skin layer. Due to the rupture of the
blood vessels cause a color on the skin that can be seen by the eye and will
change color as time passes. In the first and second images of the bruise
color is purplish red and blue which means age bruises are under the age
of 4 days. While in the third picture of yellow bruises that indicate the age
of bruising 7-10 days.
While the blisters that occur in the vagina of the patient is caused
by sexual intercourse by the husband. When a person is forced to have
sexual intercourse then the victim does not experience a phase of
stimulation so that the bartholini gland will not release mucus that serves
as a vaginal lubrication. This means that when the victim associated with
the husband, the victim's vagina in a state of dryness that causes blisters
that damage the vaginal lining. The damaged vaginal lining reaches lamina
propia which can be seen from the blood dries up in the victim's vagina.
Leslie V.Simon,Kevin C.King. Blunt Force Trauma. StatPearls Publishing
llc.NCBI.2019
Aflanie et al. 2017. Ilmu Kedokteran Forensik & medicolegal. Jakarta:PT
RajaGrafindo Persada.