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Estimating wound age: looking into the future

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Abstract

A critical review is made of the studies on wound healing used for forensic purposes, focusing on the problem of which characteristics indicate that a parameter could be used as evidence in court. A panel analysing the more important information obtained by each marker is given, and a perspective of what might be expected from future research is discussed.

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References

  1. Berg S (1972) Die Altersbestimmung von Hautverletzungen. Z Rechtsmed 70:121–135

    Article  CAS  PubMed  Google Scholar 

  2. Raekallio J (1972) Determination of the age of wounds by histochemical and biochemical methods. Forensic Sci 1:3–16

    Article  CAS  PubMed  Google Scholar 

  3. Janssen W (1984) Forensic histopathology. Springer, Berlin

    Google Scholar 

  4. Oehmichen M (1990) Die Wundheilung. Springer, Berlin

    Google Scholar 

  5. Oehmichen M (2004) Vitality and time course of wounds. Forensic Sci Int 144:221–231

    Article  CAS  PubMed  Google Scholar 

  6. Betz P (1994) Histological and enzyme histochemical parameters for the age estimation of human skin wounds. Int J Legal Med 107:60–68

    Article  CAS  PubMed  Google Scholar 

  7. Betz P (1995) Immunohistochemical parameters for the age estimation of human skin wounds. Am J Forensic Med Pathol 16:203–209

    Article  CAS  PubMed  Google Scholar 

  8. Ohshima T (2000) Forensic wound examination. Forensic Sci Int 113:153–164

    Article  CAS  PubMed  Google Scholar 

  9. Hernández-Cueto C, Girela E, Sweet DJ (2000) Advances in the diagnosis of wound vitality. A review. Am J Forensic Med Pathol 21:21–31

    Article  Google Scholar 

  10. Kondo T (2007) Timing of skin wounds. Leg Med (Tokyo) 9:109–114

    Google Scholar 

  11. Raekallio J (1960) Enzymes histochemically demonstrable in the earliest phase of wound healing. Nature 188:234–235

    Article  CAS  PubMed  Google Scholar 

  12. Raekallio J (1970) Enzyme histochemistry of wound healing. Fisher, Stuttgart

    Google Scholar 

  13. Martin P (1997) Wound healing—aiming for perfect skin regeneration. Science 276:75–81

    Article  CAS  PubMed  Google Scholar 

  14. Singer AJ, Clark RA (1999) Cutaneous wound healing. N Engl J Med 341:738–746

    Article  CAS  PubMed  Google Scholar 

  15. Gillitzer R, Goebeler M (2001) Chemokines in cutaneous wound healing. J Leukoc Biol 69:513–521

    CAS  PubMed  Google Scholar 

  16. Martin P, Leibovich SJ (2005) Inflammatory cells during wound repair: the good, the bad and the ugly. Trends Cell Biol 15:599–607

    Article  CAS  PubMed  Google Scholar 

  17. Pontieri GM, Russo MA, Frati L (2005) Patologia generale. Piccin, Padova

    Google Scholar 

  18. Swift ME, Burns AL, Gray KL, Di Pietro LA (2001) Age-related alterations in the inflammatory response to dermal injury. J Invest Dermatol 117:1027–1035

    Article  CAS  PubMed  Google Scholar 

  19. He L, Zhu J (1996) Distinguishing antemortem from postmortem injuries by LTB4 quantification. Forensic Sci Int 81:11–16

    Article  CAS  PubMed  Google Scholar 

  20. Ono E, Taniguchi M, Mita H, Fukutomi Y, Higashi N, Miyazaki E, Kumamoto T, Akiyama K (2008) Increased production of cysteinyl leukotrienes and prostaglandin D2 during human anaphylaxis. Clin Exp Allergy 39:72–80

    Article  Google Scholar 

  21. Hernández-Cueto C, Vieira DN, Girela E, Marques E, Calvo MD, Villalobos M, Oliveira de Sà F, Villanueva E (1994) Prostaglandin F2a (PGF2a ): an inadequate marker of the vitality of wounds? Int J Leg Med 106:312–314

    Article  Google Scholar 

  22. Grellner W, Georg T, Wilske J (2000) Quantitative analysis of proinflammatory cytokines (IL-1β, IL-6, TNF-α) in human skin wounds. Forensic Sci Int 113:251–264

    Article  CAS  PubMed  Google Scholar 

  23. Sato Y, Ohshima T (2000) The expression of mRNA of proinflammatory cytokines during skin wound healing in mice: a preliminary study for forensic wound age estimation (II). Int J Legal Med 113:140–145

    Article  CAS  PubMed  Google Scholar 

  24. Ishida Y, Kondo T, Kimura A, Matsushima K, Mukaida N (2006) Absence of IL-1 receptor antagonist in impaired wound healing along with aberrant NF-kB activation and a reciprocal suppression of TGF-ß signal pathway. J Immunol 176:5598–5606

    CAS  PubMed  Google Scholar 

  25. Kondo T, Ohshima T (1996) The dynamics of inflammatory cytokines in the healing process of mouse skin wound: a preliminary study for possible wound age determination. Int J Legal Med 108:231–236

    Article  CAS  PubMed  Google Scholar 

  26. Kondo T, Ohshima T, Eisenmenger W (1999) Immunohistochemical and morphometric study on the temporal expression of interleukin-1α (IL-1α) in human skin wounds for forensic wound age determination. Int J Legal Med 112:249–252

    Article  CAS  PubMed  Google Scholar 

  27. Grellner W (2002) Time-dependent immunohistochemical detection of proinflammatory cytokines (IL-1β, IL-6, TNF-α) in human skin wounds. Forensic Sci Int 130:90–96

    Article  CAS  PubMed  Google Scholar 

  28. Bacci S, Romagnoli P, Norelli GA, Forestieri AL, Bonelli A (2006) Early increase in TNF-alpha-containing mast cells in skin lesions. Int J Legal Med 120:138–142

    Article  CAS  PubMed  Google Scholar 

  29. Grellner W, Vieler S, Madea B (2005) Transforming growth factors (TGF-alpha and TGF-beta1) in the determination of vitality and wound age: immunohistochemical study on human skin wounds. Forensic Sci Int 153:174–180

    Article  CAS  PubMed  Google Scholar 

  30. Ohshima T, Sato Y (1998) Time-dependent expression of interleukin-10 (IL-10) mRNA during the early phase of skin wound healing as a possible indicator of wound vitality. Int J Legal Med 111:251–255

    Article  CAS  PubMed  Google Scholar 

  31. Takamiya M, Fujita S, Saigusa K, Aoki Y (2008) Simultaneous detection of eight cytokines in human dermal wounds with a multiplex bead-based immunoassay for wound age estimation. Int J Leg Med 122:143–148

    Article  Google Scholar 

  32. Kondo T, Ohshima T, Mori R, Guan DW, Ohshima K, Eisenmenger W (2002) Immunohistochemical detection of chemokines in human skin wounds and its application to wound age determination. Int J Legal Med 116:87–91

    Article  CAS  PubMed  Google Scholar 

  33. van der Laan N, de Leij LFMH, Ten Duis HJ (2001) Immunohistopathological appearance of three different types of injury in human skin. Inflamm Res 50:350–356

    Article  Google Scholar 

  34. Jiao A, Fish SC, Mason LE, Shelling SH, Goldman SJ, Williams CM (2007) A role for endothelial selectins and nonallergic inflammatory disease. Ann Allergy Asthma Immunol 98:83–88

    Article  CAS  PubMed  Google Scholar 

  35. Cecchi R, D’Annibale C, Valente S, Ferrera V (2004) La vitalità delle lesioni da arma bianca: studio sperimentale. Zacchia 77:49–59

    Google Scholar 

  36. Dressler J, Bachmann L, Koch R, Müller E (1999) Enhanced expression of selectins in human skin wounds. Int J Legal Med 112:39–44

    CAS  PubMed  Google Scholar 

  37. Takeuchi F, Streilein RD, Hall RP (2003) Increased E-selectin, IL-8 and IL-10 gene expression in human skin after minimal trauma: a potential explanation of regional distribution of skin lesions. Exp Dermatol 12:777–783

    Article  CAS  PubMed  Google Scholar 

  38. Nagaoka T, Kaburagi Y, Hamaguchi Y, Hasegawa M, Takehara K, Steeber DA, Tedder TF, Sato S (2000) Delayed wound healing in the absence of intercellular adhesion molecule-1 or l-selectin expression. Am J Pathol 157:237–247

    CAS  PubMed  Google Scholar 

  39. Dressler J, Bachmann L, Kasper M, Hauck JG, Müller E (1997) Time dependence of the expression of ICAM-1 (CD 54) in human skin wounds. Int J Legal Med 110:299–304

    Article  CAS  PubMed  Google Scholar 

  40. Dressler J, Bachmann L, Koch R, Müller E (1999) Estimation of wound age and VCAM-1 in human skin. Int J Legal Med 112:159–162

    Article  CAS  PubMed  Google Scholar 

  41. Takamiya M, Saigusa K, Aoki Y (2002) Immunohistochemical study of basic fibroblast growth factor and vascular endothelial growth factor expression for age determination of cutaneous wounds. Am J Forensic Med Pathol 23:264–267

    Article  PubMed  Google Scholar 

  42. Hayashi T, Ishida Y, Kimura A, Takayasu T, Eisenmenger W, Kondo T (2004) Forensic application of VEGF expression to skin wound age determination. Int J Legal Med 118:320–325

    Article  PubMed  Google Scholar 

  43. Jalkanen S, Salmi M (2008) VAP-1 and CD73, endothelial cell surface enzymes in leukocyte extravasation. Art, Thromb, Vasc Biol 28:18–26

    Article  CAS  Google Scholar 

  44. Walcher K (1936) Die vitale Reaktion bei der Beurteilung des Gewaltsamen. Dtsch Z Gerichtl Med 26:193–211

    Article  Google Scholar 

  45. Lasarov I (1988) Enzymaktivität von Leukozyten aus Schnittwunden der Haut mit verschiedener Wundaltersbestimmung. Z Rechtsmed 100:157–164

    Article  CAS  PubMed  Google Scholar 

  46. Dachun W, Jiazhen Z (1992) Localization and quantification of the nonspecific esterase in injured skin for the timing of wounds. Forensic Sci Int 53:203–213

    Article  CAS  PubMed  Google Scholar 

  47. Psaroudakis K, Tzatzarakis MN, Tsatsakis AM, Michalodimitrakis MN (2001) The application of histochemical methods to the age evaluation of skin wounds: experimental study in rabbits. Am J Forensic Med Pathol 22:341–345

    Article  CAS  PubMed  Google Scholar 

  48. Merli S, Gualdi G, Umani Ronchi G (1969) La diagnosi cronologica delle ferite cutanee. Zacchia 44:380–395

    Google Scholar 

  49. Raekallio J, Mäkinen PL (1969) Serotonin content as vital reaction I. Experimental investigation. Zacchia 44:587–594

    Google Scholar 

  50. Raekallio J, Mäkinen PL (1970) Serotonin and histamine contents as vital reaction II. Autopsy studies. Zacchia 45:403–414

    Google Scholar 

  51. Zhong FC, Zhen ZJ (1991) Localization and quantification of histamine in injured skin as parameters for the timing of wounds. Forensic Sci Int 51:163–171

    Article  CAS  PubMed  Google Scholar 

  52. Maeno Y, Takabe F, Inoue H, Iwasa M (1990) A study on the vital reaction in wounded skin: simultaneous determination of histamine and polyamines in injured rat skin by high-performance liquid chromatography. Forensic Sci Int 46:255–268

    Article  CAS  PubMed  Google Scholar 

  53. Fernández P, Bermejo AM, López-Rivadulla M, Concheiro L (1994) Biochemical diagnosis of the intravital origin of skin wounds. Forensic Sci Int 68:83–89

    Article  PubMed  Google Scholar 

  54. Yu-Chuan C, Bing-Jie H, Qing-Song Y, Jia-Zhen Z (1995) Diagnostic value of ions as markers for differentiating antemortem from postmortem wounds. Forensic Sci Int 75:157–162

    Article  Google Scholar 

  55. Hernández-Cueto C, Luna A, Villanueva E (1984) Study of Cathepsin A and D activity and Ca, Mg, Cu, Zn, Fe, Na and K concentrations in wounds edges: its application to the differential diagnosis between vital and postmortem wounds. J Forensic Sci 24:301–302

    Article  Google Scholar 

  56. Girela E, Hernández-Cueto C, Lorente JA, Villanueva E (1989) Post-mortem stability of some markers of intravital wounds. Forensic Sci Int 40:123–130

    Article  CAS  PubMed  Google Scholar 

  57. Eisenmenger W, Nerlich A, Glück G (1988) Die Bedeutung des Kollagens bei der Wundalterbestimmung. Z Rechtsmedizin 100:79–100

    Article  CAS  Google Scholar 

  58. Fechner G, Hernández M, Bajanowski T, Sepulchre MA, Brinkmann B (1993) Immunohistochemical alterations after muscle trauma. Int J Legal Med 105:203–207

    Article  CAS  PubMed  Google Scholar 

  59. Fieguth A, Feldbrügge H, Gerich T, Kleemann WJ, Tröger HD (2003) The time-dependent expression of fibronectin, MRP8, MRP14 and defensin in surgically treated human skin wounds. Forensic Sci Int 131:156–161

    Article  CAS  PubMed  Google Scholar 

  60. Betz P, Nerlich A, Wilske J, Tübel J, Wiest I, Penning R, Eisenmenger W (1992) Immunohistochemical localization of fibronectin as a tool for the age determination in human skin wounds. Int J Legal Med 105:21–26

    Article  CAS  PubMed  Google Scholar 

  61. Betz P, Nerlich A, Wilske J, Tübel J, Penning R, Eisenmenger W (1993) The immunohistochemical localization of alpha-1-antichymotrypsin and fibronectin and its meaning for the determination of the vitality of human skin wounds. Int J Legal Med 105:223–227

    Article  CAS  PubMed  Google Scholar 

  62. Betz P, Nerlich A, Tübel J, Penning R, Eisenmenger W (1993) Localization of tenascin in human skin wounds—an immunohistochemical study. Int J Legal Med 105:325–328

    Article  CAS  PubMed  Google Scholar 

  63. Ortiz-Rey JA, Suárez-Peñaranda JM, Da Silva EA, Muñoz-Barús JI, San Miguel-Fraile P, De la Fuente-Buceta A, Concheiro-Carro L (2002) Immunohistochemical detection of fibronectin and tenascin in incised human skin injuries. J Forensic Sci 126:118–122

    Article  CAS  Google Scholar 

  64. Ortiz-Rey A, Suárez-Peñaranda JM, Muñoz-Barús JI, Álvarez C, San Miguel-Fraile P, Rodríguez-Calvo MS, Concheiro-Carro L (2003) Expression of fibronectin and tenascin as a demonstration of vital reaction in rat skin and muscle. Int J Legal Med 117:356–360

    Article  CAS  PubMed  Google Scholar 

  65. Betz P, Tübel J, Eisenmenger W (1995) Immunohistochemical analysis of markers for different macrophage phenotypes and their use for forensic wound age estimation. Int J Legal Med 107:197–200

    Article  CAS  PubMed  Google Scholar 

  66. Kondo T, Tanaka J, Ishida Y, Mori R, Takayasu T, Ohshima T (2002) Ubiquitin expression in skin wounds and its application to forensic wound age determination. Int J Legal Med 116:267–272

    Article  CAS  PubMed  Google Scholar 

  67. Ishida Y, Kimura A, Takayasu T, Eisenmenger W, Kondo T (2009) Detection of fibrocytes in human skin wounds and its application for wound age determination. Int J Legal Med 123:299–304

    Article  PubMed  Google Scholar 

  68. Dressler J, Busuttil A, Koch R, Harrison DJ (2001) Sequence of melanocyte migration into human scar tissue. Int J Legal Med 115:61–63

    Article  CAS  PubMed  Google Scholar 

  69. Antoniades HN, Galanopoulos T, Neville-Golden J, Kiritsy CP, Lynch SE (1994) p54 expression during normal tissue regeneration in response to acute cutaneous injury in swine. J Clin Invest 93:2206–2214

    Article  CAS  PubMed  Google Scholar 

  70. Hausmann R, Nerlich A, Betz P (1998) The time-related expression of p53 protein in human skin wounds—a quantitative immunohistochemical analysis. Int J Legal Med 111:169–172

    Article  CAS  PubMed  Google Scholar 

  71. Ishida Y, Kimura A, Takayasu T, Eisenmenger W, Kondo T (2008) Expression of oxygen regulated protein 150 (ORP150) in skin wound healing and its application for wound age determination. Int J Legal Med 122:409–414

    Article  CAS  PubMed  Google Scholar 

  72. Bonelli A, Bacci S, Norelli GA (2003) Affinity cytochemistry analysis of mast cells in skin lesions: a possible tool to assess the timing of lesions after death. Int J Legal Med 117:331–334

    Article  CAS  PubMed  Google Scholar 

  73. Bonelli A, Bacci S, Vannelli B, Norelli GA (2003) Immunohistochemical localization of mast cells as a tool for the discrimination of vital and postmortem lesions. Int J Legal Med 117:14–18

    Article  CAS  PubMed  Google Scholar 

  74. Huttunen M, Naukkarinen A, Hosmanheimo M, Harvima IT (2002) Transient production of stem cells factor in dermal cells but increasing expression of kit receptor in mast cells during normal wound healing. Arch Dermatol Res 294:324–330

    PubMed  Google Scholar 

  75. Oemichen M, Gronki T, Meissner C, Anlauf M, Schwark T (2009) Mast cell reactivity at the margin of human skin wounds: an early cell marker of wound survival? Forensic Sci Int 191:1–5

    Article  Google Scholar 

  76. Rebolledo Godoy M, Rebolledo Godoy AP, Oehmichen M (2000) AgNORs during the process of wound healing. Time dependency as evaluated in vital and postmortem biopsy. Int J Leg Med 113:244–246

    Article  CAS  Google Scholar 

  77. Oehmichen M, Lagodka T (1991) Time-dependent RNA synthesis in different skin layers after wounding. Experimental investigations in vital and postmortem biopsies. Int J Legal Med 104:153–159

    Article  CAS  PubMed  Google Scholar 

  78. Oehmichen M, Lagodka T, Cröpelin A (1997) RNA and DNA synthesis of epidermal basal cells after wounding. Comparison of vital and postmortem investigations. Exp Toxicol Pathol 49:233–237

    CAS  PubMed  Google Scholar 

  79. Oehmichen M, Cröpelin A (1995) Temporal course of intravital and postmortem proliferation of epidermal cells after mechanical injury. Int J Legal Med 107:257–262

    Article  CAS  PubMed  Google Scholar 

  80. Sawaguchi T, Jasani B, Kobayashi M, Knight B (2000) Post-mortem analysis of apoptotic changes associated with human skin bruises. Forensic Sci Int 108:187–203

    Article  CAS  PubMed  Google Scholar 

  81. Cecchi R, Rosati R, Cave Bondi G (1999) L’apoptosi nella guarigione delle ferite cutanee. Zacchia 72:131–142

    Google Scholar 

  82. Betz P, Nerlich A, Tübel J, Wiest I, Hausmann R (1997) Detection of cell death in human skin wounds of various ages by an in situ end labelling of nuclear DNA fragments. Int J Legal Med 110:240–243

    Article  CAS  PubMed  Google Scholar 

  83. Suárez-Peñaranda JM, Rodríguez-Calvo MS, Ortiz-Rey JA, Muñoz JI, Sánchez-Pintos P, Da Silva EA, De la Fuente-Buceta A, Concheiro-Carro L (2002) Demonstration of apoptosis in human skin injuries as an indicator of vital reaction. Int J Legal Med 116:109–112

    Article  PubMed  Google Scholar 

  84. Kondo T, Ohshima T, Sato Y, Madama T, Eisenmenger W (2000) Immunohistochemical study on the expression of c-Fos and c-Jun in human skin wounds. Histochem J 32:509–514

    Article  CAS  PubMed  Google Scholar 

  85. Fieguth A, Kleemann WJ, von Wasielewski R, Werner M, Tröger HD (1997) Influence of postmortem changes on immunohistochemical reactions in skin. Int J Legal Med 110:18–21

    Article  CAS  PubMed  Google Scholar 

  86. Fieguth A, Kleemann WJ, Tröger HD (1994) Immunohistochemical examination of skin wounds with antibodies against alpha-1-antichymotrypsin, alpha-2-macroglobulin and lysozyme. Int J Legal Med 107:29–33

    Article  CAS  PubMed  Google Scholar 

  87. Hernández-Cueto C, Vieira DN, Girela E, Marques E, Villanueva E, Oliveira Sá F (1995) Diagnostic ability of D-dimer in the establishment of the vitality of wounds. Forensic Sci Int 76:141–149

    Article  PubMed  Google Scholar 

  88. Falanga V, Isaacs C, Paquette D, Downing G, Kouttab N, Butmarc J, Badiavas E, Hardin-Young J (2002) Wounding of bioengineered skin: cellular and molecular aspects after injury. J Invest Dermatol 119:653–660

    Article  CAS  PubMed  Google Scholar 

  89. Sun J, Wang Y, Zhang L, Gao C, Zhang L, Guo Z (2009) Time-dependent expression of skeletal muscle troponin I mRNA in the contused skeletal muscle of rats: a possible marker for wound age estimation. Int J Legal Med 124:27–33

    Article  PubMed  Google Scholar 

  90. Adel-Patient K, Bernard H, Ah-Leung S, Créminon C, Wal JM (2005) Peanut- and cow’s milk-specific IgE, Th2 cells and local anaphylactic reaction are induced in Balb/c mice orally sensitized cholera toxin. Allergy 60:658–664

    Article  CAS  PubMed  Google Scholar 

  91. van Wieringen T, Kimani SG, Hultgård-Ekwall AK, Forsberg J, Reyhani V, Engström A, Rubin K (2009) Opposite effects of PDGF-BB and prostaglandin E1 on cell-motility related processes are paralleled by modifications of distinct actin-binding proteins. Exp Cell Research 315:1745–1758

    Article  Google Scholar 

  92. Tarran SL, Craft GE, Valova V, Robinson PJ, Thomas G, Markham R, Langlois NE, Vanezis P (2007) The use of proteomics to study wound healing: a preliminary study for forensic estimation of wound age. Med Sci Law 47:134–140

    Article  PubMed  Google Scholar 

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Authors are grateful to Mrs. Marian Shields for help with the linguistic style.

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Correspondence to Rossana Cecchi.

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Cecchi, R. Estimating wound age: looking into the future. Int J Legal Med 124, 523–536 (2010). https://doi.org/10.1007/s00414-010-0505-x

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