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February 12, 2013
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Medical Research/Medical Question

:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
Where do you go to research medical issues to make a condition seem as realistic as possible?

I've got a character whose back right calf was cut (thin cut). I was thinking the region involves the gastrocnemius muscle, but I'm having a hard time determining how such an injury would impair said character.

Would he be able to walk (granted painfully)?
What might be a general reaction to such an injury?
And what long-lasting effects might it have since he can't get it healed right away?

My book takes place in a fantasy world (think Middle Earth) and the healers use a combination of herbs and (the healer who would heal this injury) magick. I am planning on using magick to heal most of the injury, but I have quite a bit of story to write with this injury before it can get healed.
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:iconchimeradragonfang:
ChimeraDragonfang Featured By Owner Feb 18, 2013
This doesn't really answer your question, but it's a neat resource I found a while ago that I find quite useful: Zygote Body. I use it all the time when inflicting injuries on my (humanoid) characters. Helps me visualize the damage when I can peel back the skin and see where all the muscles and internal organs are. It also has everything labelled with the proper names, which makes further research much easier.
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:iconsadict:
Sadict Featured By Owner Feb 18, 2013  Hobbyist General Artist
Ahhh! I can't visit the site! Says WebGL isn't supported by any of my browsers.

Sounds like it might be an awesome resource.
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:iconchimeradragonfang:
ChimeraDragonfang Featured By Owner Feb 21, 2013
Which browser(s) are you using? I've got whatever the newest version of Firefox is, and everything works fine with it.
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:iconsadict:
Sadict Featured By Owner Feb 21, 2013  Hobbyist General Artist
I tried IE, Chrome, and Firefox. The Firefox I re-installed, though may not be the latest. I'll have to go back and check.
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:icondanceinmyblood:
danceinmyblood Featured By Owner Feb 18, 2013   Writer
Hi there, well as a 3rd year med student myself, I can tell the first thing that you need to keep in mind is that the legs and arms are just layers of muscles, skin, and aponeurosis. First, you have the skin, then some "minor" veins (the ones you can see through your skin), maybe some thin nerves, then the aponeurosis (which is like a thin fold that covers the muscles), and then, the muscles.

There are superficial and deep (I dont know if that is the aproppiate word) muscles. Most of the important veins, arteries, and nerves are beneath those "deep" muscles. In the back of the leg, the popliteal sciatic nerve, and the popliteal vein and artery are together in a "pack" just below the back of the knee, and covered by a layer of three different muscles, including the gastrocnemius and two other more which I dont know their names in english. Those three muscles, including the gastrocnemius are very VERY thick, and it's really difficult to cut through them (personal experience, spent some time trying to dissect that area).

So, if the injury is SUPERFICIAL (with this I mean that it does not compromisse another muscles besides the gastrocnemius), your character will be able to walk (altough with some pain and difficulty). Even if no mayor veins go through that area, he will have some blood loss (specially if the injury was near the middle of the leg, where the superficial saphenous vein is), but not a mayor life threatening blood loss (if treated in time). If he reaches medical attention, he will NEED to have that stiched up, which is not that difficult and can be done quickly.

If the injury is PROFOUND, there are many consecuences, from MAYOR blood loss (if it reaches the popliteal artery or vein), to compromising his toes and feet movement (if it damaged the flexor hallucis longus, tibialis posterior, and flexor digitorum longus muscles, or the popliteal sciatic nerve).

On another note, the most important tendon is the "Achilles tendon", which connects the gastrocnemius and the other 2 muscles to the heel. Those muscles on the back of the legs bend them, while the ones on the anterior part of the legs stretch them. So, if the Achilles tendon gets completely sliced your character WILL have problems while walking. He will be unable to stand up on his toes, and step off the ground using the injured leg, meaning that he will develop a limp, at least if the tendon does not heal appropiately. The recovery takes about 6-12 months.

Hope this helped, and I'm sorry for my shitty english :)
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:iconsadict:
Sadict Featured By Owner Feb 18, 2013  Hobbyist General Artist
This helped greatly, and no worries about your English. It's really good.

Thank you so much for taking the time to write this up and help me out. I really do appreciate it. Everyone's inputs help me a lot and have helped me decide how to go back and re-write and re-work the chapter when the time comes.

Thank you again, very much for the time you took to write all of that. :hug:
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:iconexillior:
Exillior Featured By Owner Feb 15, 2013  Hobbyist General Artist
I'm a bit late to join the party, but in general, I would advise you to ask people who deal with that sort of thing. There are two groups of such people:
- Those who take care of injuries like this, e.g. physiotherapists, medics, nurses, paramedics.
- Those who have suffered injuries, e.g. athletes/sportspeople, soldiers, people who work in risky jobs.

Reading books and articles is excellent and gives a good background, but it will never give you the practical "would this happen??" answers that you need.

I am a doctor (gosh, I typed medical student there and realised I'm no longer that :lol:) so luckily I am surrounded by people who could give me answers that I don't have myself. It may seem difficult for you to get hold of such people but trust me, it is worth it. There are few things that piss me off as much as reading something that's completely impossible... and that could have been easily verified by asking somebody in the domain. Gah!

It's the same principle as writing something in a language that you're not good at. You'd go to somebody who's fluent and good at it and ask them to give it a once over. It's just the same thing.
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:iconsadict:
Sadict Featured By Owner Feb 15, 2013  Hobbyist General Artist
Thank you for taking the time to write a response. :)

I really do need to find people I can talk to about these types of questions and check out the near-by hospital in town.
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:iconexillior:
Exillior Featured By Owner Feb 15, 2013  Hobbyist General Artist
You can also ask people online. ;P There are quite a lot of medics and other healthcare professionals on dA.
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:iconsadict:
Sadict Featured By Owner Feb 15, 2013  Hobbyist General Artist
The asking online's part reason I made the thread on DA. :XD: First forum I could think to post on after midnight.
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:iconexillior:
Exillior Featured By Owner Feb 16, 2013  Hobbyist General Artist
I've switched the order of your questions because that changes the answers.

What might be a general reaction to such an injury?
There are two immediate serious problems he is at great risk of:
1. Compartment syndrome. (Reading about this will tell you enough.) He can lose his leg in 24 hours if this happens.
2. Infection. A bit more insidious but he can get septic and die in 2-3 days. Think Khal Drogo and his superficial chest cut in Game of Thrones.

Would he be able to walk (granted painfully)?
Yes. Unless you cut the tendon, which is way lower (Achilles' tendon), he can still walk. Unless he gets compartment syndrome, of course.

And what long-lasting effects might it have since he can't get it healed right away?
Longterm, the risks are the same as any cut. 1. Infection. 2. Infection. 3. Infection. This includes tetanus. 4. Since it's a superficial cut, it shouldn't lame him.

Now, something you haven't considered is whether the cut is a horizontal slash or a vertical one. If it's a vertical one, the damage to the muscle is almost laughably minimal, since muscle fibres run from one attachment to the other - in this case vertically. If it's a longitudinal one, it's going to be more painful and will take longer to heal.

The best way to approach violence in fiction is to think of it from the perspective of the person inflicting it. If you wanted to maim somebody, lame them or kill them, how would you go about it if you were them?
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:iconsadict:
Sadict Featured By Owner Feb 16, 2013  Hobbyist General Artist
Thank you for taking the time to write all of that! Incredibly helpful! I'll have to look up Compartment syndrome.
I haven't seen Game of Thrones, so I can't relate to the example you gave.


The direction of the cut is more vertical.
It wasn't inflicted with maiming in mind, but rather just causing some pain.

Again, thank you for writing all of that! It's very informative and will help.
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:iconexillior:
Exillior Featured By Owner Feb 16, 2013  Hobbyist General Artist
If you're using blades and cuts a lot in your story, you may wish to learn where tendons run, because a lot of skilled swordsmen will attack those as well as somebody's vitals. :P At least, common sense dictates they will. It's a bit like cutting a puppet's strings.
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:iconsadict:
Sadict Featured By Owner Feb 16, 2013  Hobbyist General Artist
A very good idea. I was thinking on that earlier after your last post and how I need to learn more about anatomy and other such functions of the body.
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(1 Reply)
:iconneurotype:
neurotype Featured By Owner Feb 12, 2013  Hobbyist General Artist
What long-term effects do you need there to be in the story? :B
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:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
I don't know there need to be any long-term effects, but I'm keeping my options open.

I was thinking, though, that it may be inevitable that the character is stuck with a slight limp for the rest of his life.
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:iconneurotype:
neurotype Featured By Owner Feb 12, 2013  Hobbyist General Artist
Could be interesting. :O
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:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
Yeup. :nod:
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:icondr-vergissmeinnicht:
Dr-Vergissmeinnicht Featured By Owner Feb 12, 2013  Hobbyist Writer
The fact of the matter is, most readers aren't going to be Medical Doctors or surgeons. I think if you state the character has a gash on his lower leg and it's affecting him/her and describe that character as being in pain and having a hard time, then the readers will understand. You don't need to go into the full description of the gash, since I assume it's not part of the plot. If you are writing in a fantasy set world, read up on old herbal remedies and practices.
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:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
Thanks for replying. :)

I don't want to go into full detail on the wound (shortly after it was given, magick was used to close it up, but it still hurts).
I'm just trying to find out how it might effect him in the long run---especially if he can't get it healed right away.


I have been doing quite a bit of research into herbal remedies. I've got more than enough books on herbs for healing.
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:iconmercury-crowe:
Mercury-Crowe Featured By Owner Feb 12, 2013  Professional Artisan Crafter
First off- how deep exactly is the cut? Are you talking about literally slicing the muscle in half, or just cutting into part of it?

And what did the cutting? Are you talking about a sharp object that left a clean edge, or something that tears rather than cuts the flesh?

Can he walk?

Sure. He'll probably limp and may not be able to run very well. But as long as most of the muscles and (big one) joints are intact you can usually walk.

General reaction?

Pain, bleeding, swelling. Possible infection.

Long term effects?

Again, this needs some clarification. Just because it's a fantasy setting doesn't mean they can't treat injuries. There are tons of antibacterial agents out in the woods, filling just about any wound with honey and then wrapping it will prevent infection and often is the only treatment you need even for deep wounds. And stitching up a cut isn't exactly new.

A clean cut will be pretty easy and straightforward to treat, the main issue is just stopping blood and closing the wound to keep it clean.

A jagged, dirty cut will be much harder to treat. If there is anything in the cut (dirt, etc) it will lead to infection. The edges of a ragged cut are difficult to press together, making it harder to stop bleeding and help it to heal.

A wound made by a rusty, dirty serrated blade someone picks up of the forest floor is a different animal than a nice clean cut made by a sharp sword.


Worst: Uncontrolled bleeding, infection, or blood poisoning leading to death.

Most likely: Scar and/or limp (temporary or permanent)

Temporary effects: Pain, redness, swelling, bleeding, oozing pus and/or clear liquid, stiffness, limited motion.
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:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
Thank you very much for taking the time to reply! This was quite helpful!

The cut wasn't/isn't too deep. It was actually done through a poppet (voodoo doll), and then shortly stitched up (again through poppet).

I am/was most curious about whether he'd be stuck with a limp for the rest of his life, and I'm starting to lean more towards yes.

But thanks to your post and a few by others, I think I'm on the right path to knowing how to handle this.

It's nothing something I'm going to spend forever on (as someone said, most readers aren't going to have medical knowledge to know if what I'm doing is right or wrong), but it's just something I need to know so I can portray the characters in what I feel to be an accurate way.

Thank you again for taking the time to reply to me!
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:iconmercury-crowe:
Mercury-Crowe Featured By Owner Feb 13, 2013  Professional Artisan Crafter
I always appreciate and author doing some research :) I've had to walk away from books because things are just wrong to the point where I can't ignore them anymore.
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:iconsadict:
Sadict Featured By Owner Feb 13, 2013  Hobbyist General Artist
Aww, that's too bad about the books you've had to walk from.
I haven't encountered that yet.


I tend to spend a ton of time doing a ton of frantic research for something small in my books. Or something that was going to be mentioned more or delved into....only for it not to be.

Like, this whole cut/gash/wound thing here. :XD: Now that I've gotten enough answers to satisfy my curiosity on how to react to such a thing, I've written past it without touching too much on it. Oh well. At least I know, and sometimes that's good enough for me. Even if it won't make it into the book as I imagined.
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:iconlupina24:
Lupina24 Featured By Owner Feb 12, 2013  Hobbyist Writer
If it has reached muscle tissue it is classified as a gash, not a cut. The direction of the cut can be a factor to determine how much damage and mobility your character has in his condition. Is it more lateral (run side to side), or vertical (up and down)? Did the laceration cut blood vessels or tendon also?

I doubt many characters could support much weight so yes, he may be able to walk or limp on that leg depending on the depth and direction of the cut, probably no weight if the Achilles tendon was also cut or injured.

General reaction, once the adrenaline wears off, Shaky, exhausted, sore, stiffening muscles, bruising, feeling tender. Blood loss is possible if any hit blood vessels were hit . Arteries bleed out faster than veins. The bigger the blood vessel the more it will bleed character may feel lightheaded, have trouble breathing (less blood in the body, less oxygen) go into shock or pass out.

It is very possible infection (inflamed swelling, putrid smell, oozing pus) can set in if not treated or at least kept clean, He can also bleed out, (applying pressure can reduce the blood loss). adding more damage torn muscles from overuse, Difficulty walking, loss of endurance, necrosis when dead tissue is still attached to living tissues can infect and rot living tissue (need to remove dead tissue).

Body Trauma by David W. Page MD, FACS is a good reference for wounds and injuries.
I also recommend Cecil's Essentials of Medicine, it's very organized anatomy textbook. Older versions are still applicable and cheaper. Found mine for $3-6 on amazon.
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:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
Great, thank you so very much for taking the time to reply! This has helped me.

I'll have to look up the books you mentioned. They sound like they'd be quite handy to have around---the way I like to torture my poor characters.
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:iconlupina24:
Lupina24 Featured By Owner Feb 12, 2013  Hobbyist Writer
Not a problem, a good anatomy book is indispensable even for non-writers. Also ask doctors, surgeons, pathologists, sports and alternative medicine etc., about injuries and other wounds. There are several websites where you can e-mail or chat with doctors about complications and such.

You may also want to look into Violence: A Writer's Guide by Rory Miller.
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:iconsadict:
Sadict Featured By Owner Feb 12, 2013  Hobbyist General Artist
I did think last night I need to find a doctor to talk to when I've got questions like these. I was looking at the sight of a hospital in town in hopes of e-mail them my questions, but I couldn't find a way of contact that looked right.


Oo, I will have to look into that book! Sounds like something I need.
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:iconexillior:
Exillior Featured By Owner Feb 15, 2013  Hobbyist General Artist
I would advise medical students. They're a good resource; if there is a big hospital where you are there will surely be medical students around.

Hospitals tend to be busy and short-staffed, people may not have time to talk to you during their working hours. Try to organise a time to speak to somebody when they're not too busy.
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:iconlupina24:
Lupina24 Featured By Owner Feb 12, 2013  Hobbyist Writer
Medical students, registered nurses and EMTs are also good resource too if you can't get hold of a doctor.

We all need that book. Heck, I need every book I can get hold of.
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