Ligature Mark Research Articles

DETECTION OF THE VITAL ORIGIN OF THE STRANGULATION MARK IN MECHANICAL ASPHYXIA AS AN INDICATOR OF THE DEVELOPMENT OF FORENSIC MEDICINE

Death by mechanical asphyxia occupies one of the leading positions in the structure of violent deaths. In the structure of mechanical asphyxia, one of the most common is mechanical strangulation, which includes hanging, ligature strangulation and manual strangulation. Solving the problem of the ante-mortem nature of mechanical asphyxia remains relevant in the practical work of forensic experts. In the case of mechanical asphyxia by strangulation, the most common and effective methods are the study of changes in the area of local injuries on the neck, such as the ligature mark during hanging. Aim of the study. To shed light on the process of developing methods for determining the ante-mortem nature of mechanical strangulation asphyxia by studying changes in the area of the ligature mark and to determine effective ways of solving this problem at the current stage of development of forensic medicine. Methods. Analysis and synthesis of information from literary sources available in online databases. Results. The use of macroscopic and histological methods to study changes in the area of the ligature mark may not be sufficient to resolve the issue of ante-mortem formation of injuries in the neck area during hanging, due to the extremely short period of time that elapses between the onset of the asphyxia process and the onset of death. The time interval between the onset of asphyxia and death is often insufficient for the development of a specific reactive cellular and even vascular response. Immunohistochemical examination, aimed at identifying initial reactive signs in the area of injury, is more effective in establishing ante-mortem status during extremely short time intervals between the cause of injury and the onset of death. In the case of mechanical asphyxia by strangulation, significant results have been obtained in the study of ligature marks by immunohistochemical markers such as tryptase, IL-15, CD-15, MHC-II, CD1a, AQP1, AQP3, fibronectin D, P-selectin. In addition, biochemical methods for the detection of physiologically active substances, which allow the detection of early signs of reactive changes in the skin due to injury, such as the study of the concentration of histamine, serotonin, heparin, prostaglandins F and E, as well as the ratio of certain ions, can be highly effective in diagnosing the ante-mortem nature of the ligature mark. Conclusion. The use of immunohistochemical research methods to confirm the ante-mortem formation of a ligature mark is based on the detection of markers of the inflammatory reaction, which are released before the appearance of any vascular and cellular reactions, allowing the detection of the first signs of the inflammatory reaction even within a very short period of time between the cause of injury and the onset of death. Thus, the use of immunohistochemical methods can be effective in confirming the ante-mortem nature of mechanical asphyxia, especially in cases where the use of standard histological staining methods has been ineffective. The detection of certain biochemical markers in the skin from the area of the ligature mark may be considered a promising, rapid and effective method to confirm the ante-mortem nature of strangulation asphyxia. This direction requires further research to improve its effectiveness and can be used in forensic practice to confirm the ante-mortem formation of the ligature mark.

Autopsy-Based Study of Non-accidental Violent Neck Asphyxia in Jordan: A Retrospective Study.

Background There is a global increase in the number of deaths caused by violent neck asphyxia, which includes both suicides and homicides. This research presents autopsy-based findings and analytical demographic data that are pertinent to significant medicolegal cases. Methods A retrospective examination of 113 autopsy reports of non-accidental violent neck asphyxia reported to the forensic pathology department of Al-Balqa Governorate in Jordan within the period from January 2010 to March 2023. Age, gender, and autopsy results were documented, along with medicolegal records that included toxicology reports. Conversely, information on the manner of death was derived from police inquest records. For the purpose of this research, all the cases of throttling and ligature strangulation have been determined to be homicidal, and all cases of hanging were classified as suicide. Results Males were predominant in hanging (72%), while females were predominant in ligature strangulation (82%). The mean age group in hanging was 21-35 years (51%), while the range for throttling was 36-50 years, and that in strangulation was 2-20 years. Most hanging and throttling cases showed typical external neck findings. Seventy-two percent of hanging cases (n = 68) did not exhibit any internal neck findings, while all throttling cases yielded positive results. Both hanging and strangulation by ligature cases exhibited an absence of thyroid cartilage fracture (83%). Eighty-nine cases (95%) of hanging did not exhibit any injuries to the rest of the body. However, all cases of throttling and ligature strangulation had an almost positive external body injury. In all cases of throttling and ligature strangulation, ocular petechial hemorrhage was present, whereas one-third of the hanging cases had it. Conclusion The forensic doctor must observe the pattern of ligature marks and other signs of physical assault found on the neck, meticulously examine the rest of the body, rule out other causes of death, and cooperate with the legal authorities regarding the collection of the history and death scene findings to accurately determine the manner and mechanism of death in cases of violent neck asphyxia.

Trends of Hanging Deaths in Vadodara– An Autopsy based Prospective Study

The position of knot (typical/atypical) and type of hanging (complete/partial) play an important role in the causation of death in hanging. Ligature material and ligature mark also provides information regarding manner and cause of death.Total 1803 medicolegal autopsies were performedduring one year study period, out of which 189 (10.48%) cases were of hanging. In our study, 134 (70.89%) were male and 55 (29.10%) cases were female with male to female ratio of 1:0.4. We observed that in 104 (55.03%) cases the hanging was complete whereas 85 (44.97%) cases the hanging was partial.The typical hanging cases were 62 (32.8%) andatypical hangings cases were 127 (67.2%). Soft ligature materials were used in 143 (75.66%) cases. Hard ligature materials were used in 46 (24.34%) cases.Dupatta, a soft-ligature material mostcommonly used in all cases.

A Study of Deaths Due to Hanging: A Retrospective Study a Research Paper

Hanging is one of the most common methods of committing suicide all around the world. This is retrospectivestudy conducted between June 2014 to December 2016, which included 50 cases of Hanging which were autopsiedin Mortuary of Government Medical College associated Hospital, Ambikapur, Sarguja, Chhattisgarh during thisperiod. Out of 50 cases of Hanging, 26 (52%) cases were males and 24 (48%) cases were females. Maximum numberof victims 16 (32%) were in the age group of 21-30 years. Maximum 48 (96%) cases occurred in closed place andleast number of cases occurred in open place 02 (4%). Cyanosis was seen in 46 (92%) of cases and face congestionseen in 24 (48%) cases. Ligature mark present above the level of thyroid cartilage in maximum number of cases48 (96%). Fracture of hyoid bone present in 1 (2%) case. Aim of the study was to find out incidence, trends andpatterns of hanging in Chhattisgarh.

An Unusual Case of Asphyxia by Ligature about the Thorax

Compressive asphyxia is generally defined as a type of asphyxia caused by chest or abdominal compression by a heavy object. It has also been reported that it could be caused by external compression caused by ligatures around the chest or abdomen. However, asphyxia caused by ligature around the thorax has not been reported in suicide cases. We present an unusual case of suicide in which the cause of death was attributed to asphyxia caused by a ligature around the thorax. The deceased was a 41-year-old woman who was found dead and suspended by a rope around the thorax from a rooftop railing on the twelfth floor of a building. On postmortem examination, a ‘C’ shaped ligature mark was identified around the thorax, with a pressure mark in the subcutis and focal intramuscular hemorrhages, which were consistent with the ligature mark. The cause of death was determined to be asphyxia due to external compression of the chest in a suspended position.

Delayed deaths in near-hanging cases: An autopsy study of causes and associated factors

BACKGROUND: Near-hanging refers to individuals who survive a hanging injury for various durations. However, hospitalized patients succumb to complications resulting in delayed deaths.
 AIM: to evaluate various factors associated with causes of delayed death in near-hanging events and provide insight into the improvement of emergency services.
 MATERIALS AND METHODS: A prospective autopsy-based study was conducted at the Department of Forensic Medicine, M.S. Ramaiah Medical College, between 2012 and 2021. All near-hanging cases of hospitalized patients who later succumbed to complications and were subsequently subjected to medicolegal autopsy were included in the study.
 RESULTS: Victims were commonly women aged 19–30 years. More than half of them could reach the hospital within 30 min to 1 hour, and 47.8% of them were suspended for between 1–3 min. Moreover, 65% survived for more than a day. Partial hanging with a faint ligature mark was more common, and 95.7% of them had taken off from a platform with a falling height of 1 metre. Cerebral edema and consolidation were the common postmortem findings in the brain and lungs. Death was attributed to hypoxic encephalopathy in the majority of the cases.
 CONCLUSION: Longer the duration of suspension, higher fall height, noncontact with the ground while being suspended, cerebral edema, hypoxia, pulmonary edema, hypotension, and need for resuscitation are predictors of fatal outcomes in near-hanging events.

TRAUMA AND HANGING- AN UNUSUAL CASE OF COMPLICATED SUICIDE

Suicidal deaths are very frequently encountered by forensic experts in day-to-day practice. Here, we shed light on an unusual complicated suicide case, with features of hanging, head trauma and traumatic asphyxia. Allegedly, a dead body of a 65 years old man was found stuck in a shaft between the elevator and a wall, in a multistorey building, with ligature material placed around his neck. The ligature material was torn in two parts and the other part was found tied over the railing upstairs, in proximity to the elevator shaft, in front of his room. Suicide notes were found with the body. During the autopsy, two loops of faint ligature marks were present on the neck and on further exploration, extravasation of blood was present over the strap muscles of neck and carotid sheath. Upper part of the body was congested and there was a clear line of demarcation. Head injury was also present with skull fractures and cerebral haemorrhages. Signs of asphyxia were seen on the internal organs. This case, illustrating a peculiar pattern of injuries is reported for future reference of pathologists to help in identifying and anticipating such injuries in similar cases of suicide.

Incomplete decapitation in suicidal vehicle-assisted ligature strangulation: A case report and a review of the literature

Vehicle-assisted ligature strangulation is an extremely rare suicide method. We report a case of a 43-year-old man who secured one end of a nylon rope to a tree and the other end around his neck, then got inside his vehicle and stepped on the gas, leading to an incomplete decapitation. A sharply demarcated encircling ligature mark was found upon external examination, along with a deep laceration in the anterior region of the neck. The severance plane passed between the third and fourth cervical vertebrae, with diffuse haemorrhagic infiltration of the cervical muscles, in accordance with autopsy findings reported in the literature. The lung histological examination described a large amount of red blood cells and pulmonary oedema. A review of the literature concerning suicidal vehicle-assisted ligature strangulation cases allowed us to investigate some common autopsy findings, as well as the rope features relevant to the beheading.

Establishing the Manner of Death: A 3D Reconstruction of a Case of Hanging

Establishing the manner of death is one of the most challenging tasks for forensic pathologists. We present the case of a 24-year-old woman found dead in the early morning on a flyover. The body was sitting on the ground with the back leaning against a wall. The neck was encircled by a white phone charger cable knotted to the staircase’s handrail. The victim had argued with her boyfriend and tried to jump out of his car while coming home from a wedding party the night before. After that, she left home alone with her phone charger in her hand. Due to self-harm behaviors, the first hypothesis was suicide by hanging. However, the ligature crossed immediately beneath the thyroid cartilage and encircled the neck twice horizontally; the two ends of the cable overlapped, forming a cross-over point in the front-right of the neck. Then, the ligature passed obliquely through the nape, gradually disappearing, forming a gap in the mark. The mark was sharply defined, stiff, yellow, and parchment-like. The investigators performed a three-dimensional scene reconstruction using the Trimble X7 Laser Scanner and the PC-Crash Multibody System. Even though the geometry of the ligature mark in the present case raised doubts about the manner of death, the three-dimensional reconstruction confirmed that the hanging was feasible without any external intervention.

Unusual suicide by hanging: double ligature mark with a single-stranded rope

ZusammenfassungIn Österreich begingen im Jahr 2020 1072 Personen Suizid. Die häufigste Suizidmethode stellt mit 42 % das Sicherhängen dar. Aufgabe der Gerichtsmedizin ist zu klären, ob die Ermittlungsergebnisse der Polizei mit den Obduktionsergebnissen übereinstimmen, und ob es sich tatsächlich um einen Suizid gehandelt hat. Im vorgestellten Fall zeigte sich bei einem Erhängten trotz eintourigem Strangwerkzeug eine doppelte Strangmarke am Hals. Die infrage kommenden Ursachen hierfür werden diskutiert.

Complex suicides involving the use of firearms and hanging: A retrospective study and review of the literature

IntroductionSuicides are the second most common cause of non-natural death in Germany after accidents. Most common is death by hanging, followed by the use of firearms. More frequent “simple” suicides in which one suicide method is used are distinguished from rare “complex” suicides, in which several methods are applied, whereby the combination of gunshot and strangulation is frequently chosen. Such cases require a thorough criminalistic and forensic medical examination to check the plausibility of assumed sequences of events and to detect covered-up homicides. Material and methodsA retrospective analysis of 5,400 post-mortem examinations at the Institute of Legal Medicine Giessen (2009–2018) revealed three cases in which gunshot and hanging were used to commit a planned complex suicide. ResultsCase 1: The body of a 66-year-old carcinoma patient was found hanging from a tree in a kneeling position with a bullet through the head. The post-mortem examination revealed a penetrating head shot, uninjured soft tissues of the neck, no injuries to the hyoid bone or larynx and no signs of congestion. After autopsy, the gunshot through the head was considered as cause of death.Case 2: An 82-year-old man was found dead with two bullet wounds in the chest, hanging in free suspension in a factory hall. The necropsy showed two chest entry wounds with injuries to the heart and lungs as well as a vital ligature mark and fractures of the hyoid bone and larynx without signs of congestion. The combination of hanging and the gunshot wounds was concluded as cause of death.Case 3: The body of an 81-year-old pain patient was found in his home next to a small-caliber rifle, with a noose around his neck, attached to a suspension torn from the wall. The autopsy revealed a tangential shot through the skull with superficial injury to the frontal brain and a vital cord mark on the neck with fractures of the hyoid bone and larynx without signs of strangulation. In this case, hanging was identified as cause of death. ConclusionComplex suicides are rare events, that require a thorough criminalistic and forensic medical examination Although being called complex suicides and one of the methods usually being suitable to cause death, the cause of death is not always a combined one.

A clandestine affair – A case report

According to the witnesses, crime scene and inquest report, deceased is a 30 years old female, found dead lying on floor, in her apartment house along with a male, who was found hanging from a ceiling fan in the same room. The deceased body was brought to Mortuary, Osmania General Hospital at 04:00 PM on 28/01/2023 by the Investigation Officer and requested for postmortem examination under section 174 Criminal Procedure Code. The postmortem findings were an antemortem horizontally placed ligature mark at the level of thyroid cartilage in the front of neck, internally there was an inward fracture of tip of greater horn of hyoid bone on the right side with surrounding tissue contusion. There were some small crescent shaped abrasions noted on both sides of front of neck which were suggestive of nail marks. There was a contusion over the inner surface of the scalp. With meticulous crime scene investigation and post mortem examination and interpretation of the findings cause of death was given as “Ligature Strangulation”

Analysis of female strangulation homicides in King County, Washington, from 1978 to 2022.

Asphyxia due to strangulation is an uncommon but important modality of homicide that tends to disproportionately involve female victims. The present study was designed to investigate the circumstances, motivations, and injuries associated with strangulation homicides of females and to measure trends in incidence over time. Electronic records of the King County Medical Examiner's Office in Seattle, Washington, were used to compile a data set of all homicides in King County from 1995 through 2022. A second data set of female homicides due to strangulation was constructed with additional records prior to 1995, supplemented with data abstracted from autopsy reports, and linked to the Washington Attorney General's Office Homicide Investigation Tracking System database. This comprehensive data set was used to analyze demographics, circumstances, motives, and injuries of female strangulation homicides from 1978 through 2016. The results found that, from 1995 through 2022, females accounted for 22.8% of 2394 homicides but 80.3% of strangulation homicides. The average annual rate of all strangulation homicides decreased until 2020. Mean ages of female decedents were 27.7 years in homicides associated with sexual assault, 36.8 years with domestic violence, and 63.9 years with robbery. Lethal assaults most often occurred in private homes, and perpetrators were usually well known to the victim. Injuries included petechiae in 83%; ligature marks in 20%; fingernail marks in 1.4%; hyoid fractures in 23%; and thyroid cartilage fractures in 31%. Fractures were more common in manual strangulation and in decedents of ages over 40 years.

Socio-demographic and medico-legal study of hanging and strangulation deaths in South Kerala

Hanging is a quick and very effective method used to commit suicide. The ligature material used for hanging is one of the important factors that determine the type of ligature mark or the pressure abrasion. The study was carried out at the Department of Forensic Medicine and Toxicology, Govt. Medical College in Thiruvananthapuram. The demographic characteristics of victims of hanging and strangulation as well as medico-legal findings in such situations were the key variables of the study. There were total 75 asphyxial fatalities, out of which 70 were caused by hanging and 5 by strangulation, were examined. According to the study's findings, men and young people between the ages of 21 and 40 are more likely to die violently from asphyxia. Suicidal hanging was a prevalent method among the unemployed. In the married group, hanging and strangulation deaths are more common. In most cases, a current psychological issue was the cause of suicide. Ligature marks from hanging were usually clearly defined, higher than the thyroid cartilage, discontinuous, and free of internal neck injuries.

Homicide by Hanging: a Comprehensive Review of Published Literature

Homicide by hanging is a rare incident and, in contrast to suicidal hanging cases, only limited number of homicidal hanging cases have been reported. This comprehensive review is conducted to summarize the published forensic pathology evidence in homicide by hanging. A systematic search in five journal databases resulted in 12 case reports. All articles passed the selection criteria and were appraised using JBI critical appraisal worksheet for case reports. Fourteen victims were reported which in most of the cases psychosocial background were reported. Household conflict was the common background. Reef knot was the majority knot being used. The autopsy findings vary in the studies, some of which reported intact larynx, thyroid, and hyoid cartilage. Only one case mentioned thyroid cartilage fracture. In addition to the ligature mark, other violence findings include bruises, abrasions, stab wounds, and sexual violence. Toxicological analysis was limited, only 3 case reports reported alcohol in the victim’s serum. There are no distinguishing features in the external or internal neck injuries attributable to homicidal hanging. A thorough autopsy and holistic approach should be considered. They are including demographic characteristics, location of the victim, social and psychiatric history, ligature’s characteristic, signs of violence and toxicological analysis.

A study on hanging in 167 Cases

Background: Hanging signifies an asphyxiation form which, by a noose or another constricting band tightened by body weight, is secondary to compression or restriction of the neck structures. Death due to hanging is always suicidal until and unless otherwise specified.
 Objective: To evaluate the socio-demographic characteristics in cases of death due to completed hanging in Bangladesh.
 Materials and Method: This descriptive study was conducted in the Department of Forensic Medicine, Dhaka Medical College Hospital. The period of study was from July 2020 to June 2022. A total number of 167 autopsies were done during this period on dead bodies that died due to hanging. Points regarding knot of ligature material, injury to neck structures, ligature mark, and stomach condition were noted during post-mortem examinations. All information was noted in a structured data sheet. Data were analyzed using a computer-based programme statistical package for social science (SPSS) for windows version 25.
 Result: This study shows maximum number of hanging cases 34.1% were in the age group of 21-30 years. Among the 167 suicide cases by hanging, the majority (69.5%) were male. Majority (56.9%) of the cases were married. Family disputes were most common motive 66(39.5%) and in females, the most common motive was marriage related harassment, particularly in married women 38(22.8%). Soft material like cloth, saree, orna, and dupatta was the preferred material for hanging in this study (85.6%) followed by firm materials (7.8%) like a rope. Hard material like iron wires, cable wires, etc were used very rarely (2.4%) and the victims who used these were almost always male.
 Conclusion: This culture has a great socio-economic burden due to the high incidence of suicidal hanging among young adults. The private essence of hanging and convenient access to ligature points and ligature supplies renders suicide avoidance challenging. Marital disappointment, organic disease issues, and dowry abuse are the primary reasons behind suicide hanging. Social, legal and psychiatric interventions are required to prevent suicide.
 Central Medical College Journal Vol 6 No 2 Jauly 2022 Page: 77-81

Unusual ligature mark after strangulation and skin maceration

ABSTRACT Strangulation by ligature is often homicidal and is mainly diagnosed through the detection of a ligature mark on the neck. We describe the unusual appearance of a ligature mark in a woman who was strangled and thrown into a river, where she lay for one month. On her neck, there was an irregular horizontal tear, associated with superficial ecchymosis and deep structures’ haemorrhage. We made a comparison with literature cases of unusual features of the ligature mark. The ligature mark appearance can be influenced by post-mortem modifications, effects of concealment methods, cut injuries and neck tightening resulting in decapitation. Drowning victims could show injuries similar to those resulting from hanging/strangulation. We found just a few cases of water immersion after strangulation and no cases of a ligature mark presenting like a loss of substance. We tried to explain the unusual appearance of the ligature mark in our case: the skin at the ligature mark lost the superficial layer and underwent dehydration, so soaking and maceration have been accelerated and produced the appearance of loss of substance. Finally, the study led to the distinction from other sources of traumatic action and the definition of the cause of death.

A Comparative Observational Study of Postmortem Computed Tomography and Traditional Forensic Autopsy Findings in Hanging Cases

Background: The use of advanced radiological techniques is rising in the field of forensics to supplement and validate the evidence. Postmortem Computed Tomography (PMCT) is now used as a standard procedure in many institutions to augment traditional autopsy findings. The application of PMCT in hanging cases will greatly reduce the number of invasive traditional autopsies, as hanging is the most common method of suicide in Northern parts of India. Therefore this observational study was conducted to compare PMCT with traditional autopsy in fifty hanging cases. Result: Out of 50 cases, the age of the subjects ranged between 14 years and 70 years. PMCT with the help of 3D reconstruction was able to detect external ligature marks on the neck in 92% (N=46) of cases giving a sensitivity of 92% (CI = 80.77% to 97.78%). Skin and subcutaneous tissue desiccation were identifiable in 96% (N=48) by PMCT, giving a sensitivity of 96% (CI= 86.29% to 99.51%). The muscle hemorrhage was identified in 4% (N=2) of the cases in traditional autopsy while the authors found difficulty in interpreting the muscle hemorrhage in PMCT. In detecting thyroid cartilage fracture, the sensitivity of PMCT was found to be 100% (CI= 15.81% to 100.00%) and specificity of 100% (CI=92.60% to 100.00%). In detecting hyoid bone fracture, the sensitivity was 100% (CI= 2.50% to 100.00%), and specificity of 100% (CI=92.60% to 100.00%). In addition, there was a great degree of agreement between the two observers for these findings suggesting the reproducibility of the result. Conclusions: A consistency in findings of both the PMCT and traditional autopsy was found. However, CT was unable to detect muscle hemmorhages, compared to traditional autopsy. Authors suggest the use of CT angiography to overcome this shortcoming, till then CT can only augment invasive autopsy findings not replace it

An uncommon case of self-strangulation by ligature and the importance of a crime scene visit by a forensic pathologist

Self-strangulation is an uncommon method of suicide. The body was found lying on the floor in front of the "multi-gym" inside the gym in the basement of the deceased's house. It was initially presented as a case of sudden death, but during autopsy, a ligature mark was noted over the deceased's neck and bilateral temporal regions along with findings supportive of ligature strangulation. A visit was made to the crime scene. A plausible reconstruction of events suggested that the deceased had used the metallic rope of the multi-gym for this purpose. The rope was connected to weights from one end, passed through a pulley and connected to a rod at the other end. Its width and pattern matched with the ligature mark. The deceased wound the rod end of the rope around his neck and entangled the rod to the rope over his head so that the weight attached to the other end tightened the rope around his neck and strangled him. As the rope unravelled, gravity caused the body to fall to the ground while the rope with the rod resumed its normal position due to the pull of the weight attached at the opposite end. This case is reported for its rarity and the unusual means used to commit suicide by self-strangulation.

Immunohistochemical detection of Fibronectin, P-Selectin, FVIII, HSP-70 and MRP-8 in the skin of ligature marks of suicidal hangings

The determination of vitality of skin injuries is one of the most central research areas in forensic pathology for it is often necessary to discern antemortem from postmortem damage. Typical is the case of a hanging, which should be distinguished from the postmortem suspension of a body. In this study, 15 human skin samples from ligature marks (study group) of victims of suicidal hanging and 15 uninjured skin samples (negative control group) were analyzed. In addition, 15 skin samples from ecchymoses in homicide victims with short survival intervals were investigated as a positive control group. Sections were processed for immunohistochemistry in order to detect the expression of Fibronectin, P-Selectin, FVIII, HSP-70, and MRP8. Immunohistochemical reactions were classified semiquantitatively (mild - score 1, moderate - score 2, and intense - score 3). In the ligature marks, Fibronectin was significantly less expressed compared to ecchymoses. The expression was similar to hanging marks and uninjured skin. In both ligature marks and ecchymoses, the expression of P-Selectin was significantly increased compared to uninjured skin. In both ligature marks and ecchymoses, expression of HSP-70 was significantly decreased in the epidermis compared to uninjured skin. In both ligature marks and ecchymoses, the expression of FVIII and MRP8 was significantly increased in the dermis and hypodermis compared to uninjured skin. The results of this study show that the immunohistochemical study of early inflammatory and coagulation factors could help determine the vitality of ligature marks. The combined analysis of P-Selectin, FVIII, HSP-70, and MRP-8 can be considered for this purpose.