An unusual skin lesion derived from postmortem ecchymoses in a donor skin graft site

Abstract

A 42-year-old female patient was found dead hanging in a shower room in a psychiatric hospital. The woman had suffered from a persecutory type of paranoid disorder over a long period. Six weeks prior to death, she attempted suicide by injecting gasoline into the cubital vein of her left arm. Clinical records showed that a skin graft, which was taken from the left femoral region, was transplanted to the left antecubital fossa, replacing the necrotic skin adjacent to the site where the gasoline was injected. According to the inquest records and police investigations, the body had been suspended for at least 7 h before it was discovered. Medico-legal autopsy, which was commenced 2.5 days after death, revealed early putrification of the corpse, which measured 161 cm and weighed 71.5 kg. Non-blanchable livor mortis with numerous postmortem ecchymoses involved most of the skin of the legs. The external examination of the body showed signs of her previous medical treatment, which was performed in the hospital when she had injected gasoline, in the form of a linear scar (29 cm in length) on the anterior side of the left upper to forearm and a triangular scar (5 9 4.5 cm) in the left antecubital fossa. Autopsy revealed the cause of death to be hanging, which was evidenced by the following findings: ligature mark measuring 1.5 cm in width around the neck; hemorrhage at the periosteal origin of the right sternocleidomastoid muscle; fracture of the left upper horn of the thyroid cartilage; hemorrhages under the anterior longitudinal ligament of the lumbar vertebral column (‘‘Simon’s bleedings’’). However, the most notable finding was a rectangular (8 9 4 cm) dark purple, bruise-like skin lesion surrounded by dense postmortem ecchymoses on the anterior side of the left thigh (Fig. 1). Histopathology of this lesion showed subepidermal blistering and interstitial extravasation of erythrocytes in the dermis, but without any surrounding inflammatory cellular response or thrombosis (Fig. 2).