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Evaluation of a Novel and Standardized Technique for Subcutaneous Upper Limb Dissection

Hoggard, Sam MBChB; Wilson, Charles A. MBChB, FRCPath, DipRCPath (Forensic)

The American Journal of Forensic Medicine and Pathology: June 2017 - Volume 38 - Issue 2 - p 159–161
doi: 10.1097/PAF.0000000000000309
Original Articles

It is often necessary to dissect the subcutaneous tissues to confirm or exclude the presence of cutaneous bruising. We undertook a literature search that demonstrated that there is currently no standardized technique for subcutaneous dissection, and the specific incisions and dissections used probably vary between individual pathologists. It is our experience that dissections wider than the area of cutaneous bruising visible externally often reveal bruises not identified on external inspection. We propose a standardized technique for subcutaneous dissection of the upper limb that allows direct inspection of the subcutaneous tissues of the forearm and dorsum of the hand. We have evaluated this technique by comparing the number of bruises detected on external inspection with the number of bruises verified by subcutaneous dissection. Our study has shown a significant increase in the detection of bruises on subcutaneous dissection when compared with external inspection alone. One hundred sixteen forensic autopsies in which the technique was performed were included in our series. We recorded bruises seen on external examination alone and compared the number with additional bruises that were discovered on dissecting the upper limbs. In 49 cases (42%), the technique uncovered additional bruises that were missed on external examination alone.

From the Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.

Manuscript received September 23, 2016; accepted January 22, 2017.

The authors report no conflict of interest.

Reprints: Sam Hoggard, MBChB, Department of Histopathology, 5th Floor Duncan Building, Royal Liverpool University Hospital, Daulby Street, Liverpool L7 8XP, United Kingdom. E-mail:

© 2017 by Lippincott Williams & Wilkins.