Hanging is a common method of committing suicide and a routine task in medico-legal autopsies. The hanging mark is the most relevant external sign and its characteristics are well known, but, for unknown reasons, there are major differences in reports on internal findings. We retrospectively studied 228 consecutive cases of hanging deaths. A complete standard autopsy was performed for every case. We investigated the association between the characteristics of the hanging mark and the frequency of bone, cartilage, soft tissue, and vascular injuries with the mode of suspension. Most cases (75.3%) presented some kind of bone or cartilage fracture, but these were unrelated to any of the variables studied. Vascular lesions are clearly more infrequent: intimal injuries were found in the carotid artery (9.1%), the jugular vein (2.2%), and ruptures of the carotid adventitial layer (21.7%). These could be partially associated with the use of a hard fixed noose and body weight.

Compression of the neck, either with the hands or by a ligature, is not an uncommon method of homicide. Burning of the body to try to conceal the homicide may complicate the situation by making it difficult to interpret the findings. We hereby report two cases of homicidal ligature strangulation with extensive burning of the bodies. In both cases, external findings included the presence of a soft piece of fabric around the neck that, when removed, disclosed a portion of pale, unburned skin that vividly contrasted with surrounding areas. Osteocartilaginous lesions were present in only one case. Carboxyhemoglobin levels in both cases were very low, and the histopathologic examination of distal airways for soot particles was negative.