Skin wounds vitality markers in forensic pathology: An updated review

Abstract

Wound age evaluation is one of the most challenging issues in forensic pathology. In the first minutes or hours, standard histological examination may not determine whether the wound was inflicted in the pre- or post-mortem period. While red blood cell infiltration is classically considered as a sign of vital reaction, several studies have shown that extravasation of blood cells may also occur after death and cannot be used as a reliable marker in the diagnosis of wound vitality. Numerous studies about wound vitality are available in the literature. They have evaluated markers involved in coagulation or inflammation, using various methods such as enzymology, molecular biology or immunohistochemistry. In this update, we first introduce some methodological principles. Then, we review the main studies available in the literature. Immunohistochemistry seems to be the most valuable method, given its easy application and the possibility to analyse the localization of the molecules of interest. Some markers are promising, such as CD15, TNFα, IL-6, IL-1β, TGFα or TGFβ1. Prior to their application in daily practice, these early results need to be confirmed with other studies, conducted by independent teams and integrating multiple controls. Most notably, the antibodies have to be tested in numerous post-mortem wounds. Indeed, a critical risk of overexpression in post-mortem wounds is present. Some promising markers have been later invalidated because of post-mortem false positivity. Finally, optimal sensitivity and specificity values could probably be reached by combining several markers, validated by large groups of pre- and post-mortem wounds.

Histopathological, immunohistochemical, and molecular studies for determination of wound age and vitality in rats

“…Until now, it has been difficult to determine wound timing in forensic medicine; however, it will contribute to the reconstruction of crime scenes and cause the arrest of a suspect . Forensic pathologists should establish the temporal order of injuries in cases involving multiple traumas by different offenders.…”

Reliability of Fibronectin and P-selectin as Indicators of Vitality and Age of Wounds: An Immunohistochemical Study on Human Skin Wounds

“…Estimation of wound age remains a major concern in forensic investigations. The forensic pathologist has to differentiate between antemortem (AM) and postmortem (PM) wounds, as well as try to determine the survival time of the injured person (Ishida et al, 2009 andCasse et al, 2016).…”

An “up, no change, or down” system: Time-dependent expression of mRNAs in contused skeletal muscle of rats used for wound age estimation

“…Multiple markers and candidates have been detected at both the protein [22] and mRNA levels [23,24]. Among them, cytokines and growth factors were considered especially promising [25], such as CD15, TNFα, IL-6, IL-1β, TGF-α, and TGF-β1 [3]. Ratios of mRNAs and positive cells have also been used as observation indexes.…”

“…Many studies have been conducted to assess wound vitality and estimate wound 3 ages over several decades, and multiple parameters have been tested with respect to time-dependent appearance in wound healing [2]. Unfortunately, no reproducibility data was reported in most studies [3]. An increasing number of forensic pathologists are conscious that no single parameter alone will provide forensic safety; a combination of multiple data points has recently been considered as a promising way to narrow the margin of error when determining the age and vitality of a wound [4,5].…”