Forensic Science, Medicine and Pathology

https://doi.org/10.1007/s12024-018-9957-y

IMAGES IN FORENSICS

“Defense” type wounds in suicide

Siobhan O’Donovan 1,2 & Neil E. I. Langlois 1,2 & Roger W. Byard 1,2

Accepted: 19 January 2018

# Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract
“Defense” type wounds are sustained when a victim is attempting to ward off an attacker, or a weapon. A 39-year-old
woman is reported who was found deceased with incised wounds to the dorsa of both hands that resembled defense
wounds. Examination of the flexor surfaces of both wrists, however, revealed horizontal incised wounds typical of
self-infliction. Perfusion of the subclavian arteries produced leakage of water from peripheral veins within wounds on
both hands and the right wrist. Death was due to exsanguination from incised wounds of the hands and right wrist;
manner suicide. This case demonstrates the difficulties that may arise in differentiating self-inflicted from assaultive
wounds. On occasion suicidal sharp force injuries may be multiple and in atypical locations. In these circumstances a
high index of suspicion for homicide must be maintained.

Keywords Sharp force . Suicide . Defense-type . Incised . Homicide

Case report
A 39-year-old woman was found deceased in a bath at their
home address by her husband. She was wearing a cotton
blouse, brassiere and underwear. The bath was partly filled
with blood-stained water with her head above the water line.
Electrical items including a kettle and a hairdryer were present
in the bathroom, as well as razors in the kitchen that had been
disassembled to remove their blades.
At autopsy the body was that of a well-nourished
Caucasian female. The major external findings involved the
hands and wrists.
Right hand On the dorsum of the right hand there was a 2 cm
oblique incised wound between the index and middle finger
metatarsal bones just proximal to the metacarpophalangeal
joints. The radial edge of the wound was ragged and irregular.
Just proximal to the metacarpophalangeal joint of the ring
* Roger W. Byard
roger.byard@sa.gov.au
1
Adelaide Medical School, The University of Adelaide,
Adelaide, South Australia, Australia
2
Forensic Science SA, Adelaide, South Australia, Australia
finger, there was a “Y” shaped full thickness incised wound
measuring 1 × 1.8 cm (Fig. 1).
On the flexor surface of the right wrist there was a 2 cm
horizontal incised wound that involved the full thickness of
the skin and cut an underlying tendon and veins. The wound
was surrounded by red/purple bruising in an area measuring
3 × 3 cm (Fig. 2).
Left hand On the dorsum of the left hand there was an
oblique 2 cm superficial incised wound of the skin, just
proximal to the metacarpophalangeal joint of the index
finger. There was also a near vertical full thickness in-
cised wound of the skin that measured 1.5 cm in length
between the middle and ring finger metatarsal bones, just
proximal to the metacarpophalangeal joints, with sur-
rounding purple bruising (Fig. 3).
On the flexor surface of the left wrist, there was a 3.5 cm
full thickness incised wound towards the ulna side that ex-
posed muscle and tendon in its base. An approximately hori-
zontal 2 cm interrupted full thickness incised wound extended
from this towards the thumb, and a further 2.5 cm slightly
oblique incised wound ran proximal to this, also towards the
radial side of the wrist (Fig. 4).
Perfusion of the subclavian arteries using previously de-
scribed methodology [1] produced leakage of water from periph-
eral veins within the wounds on the dorsum of the left hand, the
dorsum of the right hand and flexor surface of the right wrist.
 Forensic Sci Med Pathol

Fig. 1 The dorsum of the right

hand showing a 2 cm oblique
incised wound between the index
and middle finger metatarsal
bones just proximal to the
metacarpophalangeal joints.
Proximal to the
metacarpophalangeal joint of the
ring finger there is a “Y” shaped
full thickness incised wound
measuring 1 × 1.8 cm

No other significant injuries were observed; specifi- Discussion

cally there were no facial or conjunctival petechiae,
neck bruises or fractures of the thyroid cartilage or hy-
oid bone. There were no underlying organic diseases
present which could have caused or contributed to
death. Vitreous electrolyte levels were normal and toxi-
cology revealed elevated but not lethal levels of the
antihistamine doxylamine. Death was attributed to ex-
sanguination from incised wounds of the hands and
right wrist. After a full police investigation the manner
was ruled suicide.
“Defense” type wounds are useful markers that may assist
in identifying a victim, distinguishing them from an as-
sailant. These are wounds that are sustained when a vic-
tim is attempting to defend him or herself by warding off
an attacker, or a weapon, and indicate that the victim was
conscious for at least part of the time of the attack.
Typical sharp force defense injuries include incised
wounds to the fingers when a blade has been seized, or
through and through stab wounds of defensively-held

Fig. 2 The flexor surface of the

right wrist showing a 2 cm
horizontal incised wound with
surrounding red/purple bruising
Forensic Sci Med Pathol

Fig. 3 The dorsal surface of the

left hand showing an oblique
2 cm superficial incised wound of
the skin, just proximal to the
metacarpophalangeal joint of the
index finger. A near vertical full
thickness incised wound of the
skin (1.5 cm) lies between the
middle and ring finger metatarsal
bones, proximal to the
metacarpophalangeal joints, with
surrounding purple bruising

forearms. Raising the hands against a knife may also re-
sult in this pattern of injury [2].
The significance of these types of wounds is that they
suggest that an assault has occurred. An important focus
in the evaluation of an alleged victim of an attack with a
sharp weapon is, therefore, in separating self-inflicted
injuries from those that may have been inflicted by an-
other [3, 4].
Injuries inflicted by another tend to be randomly dis-
tributed, reflecting the chaos of a violent assault. They are
often found on the upper aspect of the body, particularly
on the posterior aspects of the hands and forearms, the
palms, and the inner sides of the fingers and interdigital
spaces [3, 5, 6]. These sites are vulnerable as they may be
injured in attempts to protect and shield the body from
sharp weapons [5]. Defense wounds also equally distrib-
ute on the posterior and anterior surfaces of the body and
show no left or right predominance [7].
On the other hand, self-inflicted wounds often have
quite characteristic features that can be useful in differen-
tiating them from injuries sustained in an assault. They
are found in anatomically accessible locations such as
the wrists and thighs, are often symmetrical and form
parallel or cross hatched lines that are quite superficial
and of uniform depth [8]. So-called “hesitation or tenta-
tive wounds” indicate that more than one attempt has been

Fig. 4 The flexor surface of the

left wrist with a 3.5 cm full
thickness incised wound towards
the ulna side and an
approximately horizontal 2 cm
interrupted wound extending
towards the thumb. There is an
additional 2.5 cm slightly oblique
incised wound proximal to this

made at cutting a particular area, a feature uncommon in
violent assaults. These are shallow wounds near and often
parallel to deeper wounds [9, 10]. Thus, superficial right
angled scratches on both upper anterior thighs are much
more likely to be self-inflicted than irregular deep stab
wounds to the back. Suicides by self-inflicted incised
wounds are uncommon accounting for less than 2% of
cases in the local population [11].
In the reported case the presence of full thickness,
sometimes irregular incised wounds to the dorsa of both
hands raised the possibility of defense wounds, suggest-
ing that the backs of the hands had been used to shield
the decedent from a knife attack. Their location was un-
usual for self-inflicted wounds. However, closer exami-
nation of the wound near the base of left index finger
revealed hesitation marks, as did the incised wound of
the left wrist. The position of the accompanying wounds
on the wrists was also very typical of self-infliction, as
was the relative symmetry of all of the injuries on the
wrists and dorsa of the hands. The majority of individuals
who cut their wrists incise both sides [11]. It appeared
most likely, therefore, that all of the injuries had been
inflicted by the decedent. The presence of electrical
equipment in the bathroom suggests that electrocution
in the bath may have been a back-up method to be used
if exsanguination failed.
This case demonstrates that differentiating self-inflicted
from assaultive wounds may sometimes be not particular-
ly straightforward [12]. Suicides where sharp weapons
have been used may be characterized by atypical injuries
that may on occasion be multiple [13], and self-inflicted
injuries may sometimes resemble defense wounds. In all
of these situations a high index of suspicion for homicide
must be maintained.
Forensic Sci Med Pathol
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