Forensic wound examination

doi:10.1016/S0379-0738(00)00269-3

Forensic Science International

Volume 113, Issues 1–3, 11 September 2000, Pages 153-164

https://doi.org/10.1016/S0379-0738(00)00269-3 Get rights and content

Abstract

Wound examination is of prime importance in forensic pathology, and it is desirable to establish a wound examination system in order to evaluate and record the nature of wound more accurately and objectively. Modern diagnostic techniques and devices as well as advanced cell-biological methods should be introduced as the means for this aim. For example, radiological, endoscopic or magnetic resonance imaging (MRI) examination have been used in addition to examination with the naked eye. In our department, a binocular surgical operating microscope is routinely employed at forensic autopsy, which is useful for elucidating the nature of wound in more detail. It is also necessary to determine whether a wound has vitality, and, if antemortem, how long before death the wound has been sustained. For the determination of wound age including vitality, various biological factors such as cytokines and extracellular matrix components involved in wound healing have been examined by histopathological methods. Our studies have shown that interleukin (IL)-1α, IL-1 b, IL-6, IL-10 and tumor necrosis factor-α are possibly useful markers for wound age determination as well as cell-biological indicators of vitality. Furthermore, molecular biological techniques have been intended to be applied to wound examination; our experimental study has shown that even mRNA of cytokines mentioned above can be histologically detected by reverse transcriptase–polymerase chain reaction or in situ hybridization. A trial of forensic wound examination from macroscopic to molecular level is discussed.

Introduction

In forensic pathology, it is needless to say that wound examination is the most important matter and that it requires much experience of forensic practice. It is indispensable to establish the comprehensive and systemic wound examination procedure. This means, in order to exactly diagnose the cause and manner of death, it is essential to describe the findings of wounds correctly and objectively as much as possible. In fact, forensic studies themselves, including basic studies on wound examination, should be directed to forensic practices. In other words, studies without forensic aspects are not so valuable and might be even complacent.

Section snippets

Definition and type of wound from the viewpoints of forensic pathology

Knight [1] defines ‘wound’ in his famous textbook. Namely, a wound or injury can best be defined as ‘damage to any part of the body caused by the application of mechanical force’.

In forensic pathology, wounds are classified into three different types according to the manner of the mechanical force to the skin as follows: blunt injury, sharp weapon injury and gunshot wound. Furthermore, blunt injuries are sub-classified into abrasion, laceration, bruise and intradermal bleeding. Sharp weapon

The application of clinical techniques and devices to wound examination

Although macroscopic and histological examinations are routinely performed at forensic autopsy, wound examination should be improved and renovated with the advance of medical science and medical appliances. Thus, it is desirable that modern diagnostic techniques and devices are used at forensic practices.

Examination of gunshot wounds

Karger et al. [23] mentioned that gunshot wounds should be examined radiologically, pathologically and histologically. Especially, it is important to estimate firing range and to differentiate the entrance from the exit. Brown and co-workers [24], [25] performed an image analysis of gunshot residue on entry wounds and concluded that it is possible to distinguish a contact shot from all other more distant shots, and shots at distance of ≤20 cm from those at distances of >20 cm. The image

The determination of wound vitality or wound age

It is also necessary to determine whether a wound has vital reaction, or, if the wound has vital reaction, how long before the wound has been sustained. In other words, the determination of wound vitality or wound age has to be always performed. For example, age of bruises are estimated based on the temporal change or transition of their color [27], [28], [29]. Such age estimation of bruises is important when a cadaver or injured person has plural bruises of different ages, especially in child

The attitude of forensic pathologists to wound examination

Finally, most forensic practice is in autopsy work. Naturally, forensic pathologists cannot hear directly the voice of a deceased body. However, we, forensic pathologists, have to make every effort to find the truth through many different approaches with various methods. This task is really very difficult, but it is also worth accomplishing.

Acknowledgements

The author sincerely thanks Professor Dr. med. C. Rittner (the Congress President of the 4th International Symposium of Advances in Legal Medicine in Mainz, September, 1999) for an honorable opportunity of plenary lecture at the congress.

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Forensic imaging technology has rapidly advanced over the past several decades and is gaining increasing significance in medico-legal death investigations. Medical-grade computed tomography (CT) is now routinely used in post-mortem examinations at numerous institutions across the globe. However, the resolution of medical-grade CT is limited and unsuitable when used to depict some smaller anatomical structures or micro-trauma. High-resolution micro-CT offers up to 100× the resolution to overcome this problem but is a very recent addition to the field of forensic radiology. Few studies so far have attempted to validate the results which is an essential prerequisite for it to be used in the criminal justice process as demanded by regulatory bodies. This study directly compares micro-CT images with histology, the current gold standard. Three cases were examined: two larynges from suspected strangulations and one ribcage of a case of fatal child abuse. A strong correlation was observed between histology and micro-CT as the majority of skeletal injuries were identified correctly. This paper discusses the forensic implications of the results and how micro-CT is complementary to histology.
Determination of skin wound age by using cytokines as potential markers
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Interleukin-1 beta (IL-1β), IL-6, tumour necrosis factor-alpha (TNF-α) and epidermal growth factor (EGF) play important roles in the wound healing process. In the present study, human wound specimens (n = 50) were collected from cases of death due to injuries from firearms, penetrating trauma by sharp objects and blunt trauma with a known time of injury and death identified by forensic autopsy. Full-thickness tissue specimens were obtained from injured skin sites, and equally sized intact tissues obtained from the same person were used as controls. Protein determination was performed using ELISA according to the Bradford method for each specimen, and results were provided for individual proteins. IL-1β levels did not reach statistical significance in any of the wound groups and were not markedly higher than those in the control group. However, IL-6 showed a biphasic pattern and reached statistical significance in the group with wounds less than 30 min old and in the group with wounds more than 18 h old. IL-6 was consistently higher in all wound groups than in the control group. TNF-α showed a statistically significant increase within the first 30 min and remained at a high level in all groups except for those with wounds 2–4 h old. On the other hand, EGF was high in all groups excluding those with wounds 2–4 h old and more than 18 h old, but statistical significance was not reached. Our results suggest that IL-6 and TNF-α in particular may be used as early-phase markers. We believe that IL-1β and EGF should be more extensively evaluated in further studies.
Comparison of the homogeneity of mRNAs encoding SFRP5, FZD4, and Fosl1 in post-injury intervals: Subcellular localization of markers may influence wound age estimation
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The inter-group heterogeneity and intra-group homogeneity of relative expression are very necessary when the mRNA were used to determine wound age accurately in forensic medicine. The aim of this study was to assess the intra-group homogeneity of SFRP5, FZD4 and Fosl1 mRNAs in post-injury intervals. The corresponding proteins show different subcellular locations. A total of 78 Sprague–Dawley rats were divided into control and contusion groups. At 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, or 48 h (n = 6 per group) after contusion (under anesthesia by chloral hydrate intraperitoneally), the rats were sacrificed using a lethal dose of pentobarbital, and samples of the injured muscles were collected. The raw Ct values of SFRP5, FZD4, and Fosl1 mRNAs were obtained using real-time PCR. After normalized to RPL13 mRNA levels, the coefficient of variation (CV) and the relative average deviation (d%) of each normalized Ct, and their relative expression levels, were calculated in each post-injury interval. Two methods were applied to compare the homogeneity of the three genes. First, each gene was given a score based on its CV value in each post-injury interval. Then, the sum of the 13 scores was calculated; a low sum indicated high homogeneity. Second, the 13 calculated CVs or d%s were used as raw data, which was described as the mean ± SD. Based on this mean ± SD, a CV of the CVs and a d% of the d%s were calculated to represent the variation; a low value indicated high homogeneity. The sum of the variability of FZD4 mRNA was lower than those of the SFRP5 and Fosl1 mRNAs, consistent with the results that the FZD4 mRNA had the lowest mean, the smallest CV of all CVs, and the smallest d% of all d%s, among the three genes. In conclusion, these data indicated that mRNA encoding membranous FZD4 was likely to be more homogeneous than those encoding SFRP5 and Fosl1 within post-injury intervals.
Immunohistochemical detection of CD14 and combined assessment with CD32B and CD68 for wound age estimation
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Citation Excerpt :
However, it is difficult to accurately and objectively diagnose wound age at a stage as early as <7 days, particularly in 1–5 days postinfliction, using this method. Several studies have conducted wound age estimation using biological substances [3–11]; however, only a few markers and methods were effective for high-accuracy wound age estimation in 1–5 days postinfliction. Therefore, identifying a marker and establishing a method for estimating wound age in 1–5 days postinfliction is important in forensic practice.
Estimation of wound age is a major topic of study for forensic pathologists, but few markers exist that can indicate a specific period 1–5 days postinfliction, and a method to estimate wound age with high accuracy has not yet been established. This study examined CD14 as such a marker in mouse skin wounds of different ages (0 min and 1, 2, 3, 5, 7, and 9 days) and in human subjects (group 1, 0–1 day; group 2, 1–5 days; group 3, >7 days) using Western blot analysis and/or immunohistochemical staining. In addition, we evaluated a combination of immunohistochemical markers in human skin wounds using transmembrane proteins, CD14, CD32B, and CD68, expressed on inflammatory cells. The expression of CD14 was detected only during 1–5 days postinfliction and, thus, the evaluation of CD14-expressing cells could specify wound age during 1–5 days postinfliction in mouse skin wounds. The ratio of samples assessed to be CD14⁺ was significantly high in human skin wounds in group 2. Combined assessment using the three markers increased the specificity of diagnosis and shortened the range of wound age, compared with the assessment using a single marker. Our results indicate that CD14 may be a useful marker of wound age, 1–5 days postinfliction, and that combined assessment with CD14, CD32B, and CD68 may be a good method for the accurate estimation of wound age.
Healing and Repair of Wounds and Bones
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In the field of forensic medicine, it is often of paramount importance to estimate accurately the time at which an injury was inflicted. This chapter illustrates what a forensic histopathologist needs to know in order to assess wound age. Knowledge of wound healing (WH) processes and of cellular–extracellular matrix (ECM) mediators is required to estimate wound age. In this chapter, in which studies conducted over the last decade are reviewed, the WH features that are most relevant to forensic studies and the most reliable markers of wound age assessment are described. Lastly, the new perspectives provided by omics sciences that pave the way for future interdisciplinary research are discussed.
Record of postmortem injuries caused by the Neotropical social wasp Agelaia fulvofasciata (Degeer) (Hymenoptera, Vespidae) on pig carcasses in the Eastern Amazon region: Implications in forensic taphonomy
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Postmortem injuries are a source of misinterpretations in forensic analysis and therefore are subject matter of taphonomic interest. Many types of injuries can cause different artifacts, which deserve attention of the forensic pathologists when evaluating corpses, either at the crime scene or during an autopsy. Insects can be important biotaphonomic agents and their activity may result in artifacts that resemble antemortem injuries. Here, we describe postmortem injuries caused by the Neotropical wasp Agelaia fulvofasciata (Degeer, 1773) on domestic pig carcasses weighting 15 kg. The specimens showed extensive injuries to the lower lip, similar to lacerations, and some minor lesions on the snout and anus. In addition, we observed the same wasp species preying on larvae of Sarcophagidae (Peckia sp.). Besides causing postmortem injuries, the ability of this species to detect carcasses in the early and fresh decomposition stages should be noted. Thus, future applications aiming criminal, any biotaphonomic events caused by carrion insects need to be disclosed.

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Forensic wound examination

Abstract

Introduction

Section snippets

Definition and type of wound from the viewpoints of forensic pathology

The application of clinical techniques and devices to wound examination

Examination of gunshot wounds

The determination of wound vitality or wound age

The attitude of forensic pathologists to wound examination

Acknowledgements

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

J. Clin. Forensic Med.

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Forensic Sci. Int.

Acta Histochem. Bd.

Exp. Toxicol. Pathol.

Forensic Sci. Int.

Diagnostic postmortem angiography of fatal splenic artery haemorrhage

Z. Rechtsmed.

Sudden fatal or non-operable bleeding from ruptured intracranial aneurysm. Evaluation by post-mortem angiography with vulcanising medium

Int. J. Legal Med.

Post-mortem cast angiography in the diagnostics of graft complications in patients with fatal outcome following coronary artery bypass grafting(CABG)

Int. J. Legal Med.

Forensic application of angiography on injured brain

Med. Sci. Law

Simple method for demonstrating coronary arteries at postmortem examination

Am. J. Forensic Med. Pathol.

Postmortem coronary subtraction angiography

Am. J. Forensic Med. Pathol.

Identification by MRI

Z. Rechtsmed.

Einsatzmöglichkeiten für Rhinoskopie und Otoskopie bei der forensischen Autopsie

Beitr. Gerichtl. Med.

Postmortale endoskopische Diagnostik

Beitr. Gerichtl. Med.

Forensic diaphanoscopy: how to investigate invisible subcutaneous hematomas on living subjects

Int. J. Legal Med.

Zur Anwendung des Operations-Mikroskopes in der gerichtlichen Medizin

Beitr. Gerichtl. Med.

Damage to clothing-cuts and tears

J. Forensic Sci.

Morphological findings in the brain after experimental gunshots using radiology, pathology and histology

Int. J. Legal Med.

Inorganic lead concentration analysis at the gunshot wounds for differentiation of entrance from exit hole

Acta Crim. Japon.

Estimation of the age of bruising

Arch. Dis. Child.

Timing of wounds in forensic medicine

Jpn. J. Legal Med.

On the enzymatic response to injury and its mediators

Med. Biol.

Praktische Erfahrungen mit den biochemischen vitalen Reaktionen

Beitr. Gerichtl. Med.

Estimation of time in forensic biology and pathology

Am. J. Forensic Med. Pathol.

Timing of wounds: an introductory review

Ann. Acad. Med.

Nachweis simulierter Selbstmorde mit der biochemischen Altersbestimmung von Verletzungen

Beitr. Gerichtl. Med.