Journal of Clinical Forensic Medicine (2003) 10, 255–258� 2003 Elsevier Ltd and AFP. All rights reserved.doi:10.1016/j.jcfm.2003.08.003

SHORT REPORT

Periligature injuries in hanging

Manoj Kumar Mohanty, Prateek Rastogi, G. Pradeep Kumar, Virendra Kumar,Shahnavaz Manipady

Department of Forensic Medicine, Kasturba Medical College, Manipal 576104, Karnataka, India

SUMMARY. Hanging is a common mode of suicide while ligature strangulation is a common way of homicide.Ligature marks (patterned abrasion caused by ligature material) can be of great significance to the forensicpathologist in determining the cause and manner of death. Ligature material usually produces a prominentmark over the bight area, which is opposite to the knot and an inverted ‘V’ pattern at the site of the knot. Apartfrom ligature mark, sometimes findings such as rope burns & nail marks may be seen around the ligature markand can be termed as ‘periligature injuries’. Nail marks over the neck are usually suggestive of throttling. Butthey can also be self inflicted by the victim while trying to extricate himself/herself from the strangling grip ofhanging or ligature strangulation. Such injuries, when present may mislead the forensic pathologist in drawingconclusion as to whether it is due to hanging or manual strangulation. Rope burn is caused by friction of ropeagainst skin leading to blister formation. Thus it is an antemortem feature. We present two cases of hangingwith periligature injuries.� 2003 Elsevier Ltd and AFP. All rights reserved.

Keywords: Hanging; Antemortem; Periligature; Nail marks; Rope burns

Journal of Clinical Forensic Medicine (2003) 10, 255–258

INTRODUCTION

Hanging is a common suicidal option yet a largenumber of controversies regarding its homicidal na-

ture do arise. A ligature mark is an important finding

in such cases and its careful observation and docu-

mentation can unravel the mystery. A ligature mark

is a pressure furrow (patterned abrasion) on the neck

whose depth varies inversely with the width of the

constricting agent.1;2 The mark is pale and anemic at

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––

Manoj Kumar Mohanty, M.D., Assistant Professor, Prateek

Rastogi, M.B.B.S, Post graduate & Tutor, G. Pradeep Kumar,

M.D., Dip.Cr.Law., Professor & Head, Virendra Kumar, M.D.,

Assistant Professor, Shahnavaz Manipady, M.D., Assistant

Professor, Department of Forensic Medicine, Kasturba Medical

College, Manipal 576119, Karnataka, India.

Correspondence to: Manoj Kumar Mohanty, M.D.,

Tel.: +91-820-2571201ext.22450; Fax: +91-820-2570061;

E-mail: manmohanty@yahoo.com

255

first but as the post mortem interval increases it be-

comes brown and parchment like in consistency.2 Themark can be discontinuous or even absent if sus-

pended for short time by a broad, soft and yielding

material while it is more distinct if material is hard

and suspension is prolonged.3;4 Articles like clothing,

necklace, beard, hairs, fingers in between ligature and

neck can lead to variation in the pattern. Presence of

tight jewellery, tight collar etc. around the neck in

decomposed and putrefied bodies produces a pattern,which simulates ligature mark.3;5;6

Associated injuries around the ligature mark likerope burns, nail marks and bruises can be seen. Ropeburns are caused by friction of rope against the skin.Such friction generates considerable heat, whichcauses second degree burn to develop, it is more likelythat the friction will produce blisters by expressingtissue fluid into the upper layers of skin.7 Thus thepresence of rope burns is suggestive of an antemor-tem nature of hanging. They are usually producedwhen the ligature material used is a rough one likenylon or coir rope, and are absent if soft and smoothligature like a broad cotton material is used.

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Nail marks are usually thin, linear, crescentric(half-moon) abrasions of skin. If present their ap-pearance depends on length and contour of nail andthe nature of the skin.1;7 When the nails are pointed,paradoxical results in the form of reverse crescentsmay be seen due to anchorage of skin to the pointedportion of the nail, while on the other hand nails withstraight border give unpredictable results.2;4 Nailmarks when present on the neck, may mislead thepathologist as to their manner of causation, suicidalhanging, ligature strangulation or throttling. Duecare should be taken in describing and interpretingthe marks in such cases before giving an opinion re-garding the manner of death. In the present study twocase reports describe rope burns and nail marks re-spectively which seem to be of particular interest toForensic Pathologist.

CASE ONE

A 14-year old girl committed suicide by hanging at 9a.m., at the attic of her house by a shawl fastened tothe beam, as she was afraid of failing an examinationon the previous day of postmortem examination. Shewas rescued and transferred to hospital. On the wayto hospital she died. The ligature mark was darkbrown in colour, dry and parchment like in appear-ance. It was situated in the upper 1/3 of the neck,

Fig. 1 Nail marks adjacent to the ligature marks in case of suicidal h

above the thyroid cartilage, in the midline. The markwas running obliquely upward and backward, on ei-ther side of the neck, upto a point below and behindthe mastoid process, merging with hairline at theback. A bite mark was present on the mucosal surfaceof lower lip. Marks of defibrillator were present overthe chest on left side. There were 3 nail marks (oneabove and two below the ligature mark) in front ofthe neck in the midline. This is a scratch abrasion bynature and skin tags of the nail marks were pointingdownward (as shown in Fig. 1). Internal neck struc-tures were intact. All organs were congested.

CASE TWO

A 28-year-old male person was last seen at 5 p.m., onthe previous day had committed suicide by hangingusing a coir rope with a running noose around theneck. The body was found inside the house hangingwith the ligature material in situ. The ligature markwas reddish brown in colour, dry, hard and parch-ment like in appearance. It was situated in the upper1/3 of the neck, over the thyroid cartilage, in themidline. The mark was running obliquely upwardand backward, on either side of the neck, upto apoint below and behind the mastoid process, mergingwith hairline at the back. The tongue was protrudedand bitten, shows black discolouration over exposed

anging pointed by white arrows.

Fig. 2 Blister (rope burns) above the ligature marks pointed by white arrows.

257257Periligature injuries in hanging

area. A few small blisters were present on either sideof the ligature mark (as shown in Fig. 2). There wasdribbling of saliva from the center of right half oflower lip. Internal neck structure shows fracture ofleft cornu of thyroid cartilage with contusion of ad-jacent structure. Internal organs were congested. Theestimated time since death at the time of postmortemexamination was approximately 12–18 h.

DISCUSSION AND CONCLUSION

Ligature mark is vital evidence in asphyxial deaths.The course and direction of ligature mark helps indetermining the type of asphyxial death, hanging orstrangulation. The pattern and direction of the nailmarks over the neck will help us to interpret the na-ture of their causation, throttling or suicidal hanging.A victim may often try to extricate or remove theligature by using his or her hand. During the processof removal of the ligature the nails of the victimproduces periligature injuries, which are on exami-nation revealed to be scratch abrasion. When nailmarks present alone (without ligature marks) it is

commonly suggestive of manual strangulation. But itis very difficult to give an opinion as to the manner ofdeath when associated with ligature marks. Scratchabrasion over the neck being multiple in number, deepand associated with contusion and extensive deepertissue involvement are usually suggestive of ligaturestrangulation.8 In victims of ligature strangulationsuch scratches may be found near the ligature markand are usually vertical, but may be irregular orcrescentric.9 The victims of suicidal hanging may at-tempt to pull away the ligature as a reflex action topreserve life, thus inflicting nail marks on the neck.2;3;9

In attempted resuscitation, nail marks can also beproduced by the rescuer while trying to remove theligature.3;9 It is vital to correlate them with otherfindings before opining the manner of death.

In case of hanging, apart from giving an opinionon the cause of death, the forensic pathologist has tocomment on the nature of hanging for escape hassuspension antemortem or postmortem? A salivadribble mark is the classical feature of antemortemhanging, but may not be present in all cases. ‘Ropeburns’ which are produced when tough ligaturematerial like coir or nylon rope is used because of

258 Journal of Clinical Forensic Medicine

friction between skin and ligature material helps toascertain antemortem nature of hanging.

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