Case report

Medicine, Science and the Law

2016, Vol. 56(1) 53–57
Cut-throat wounds: Suicidal and ! The Author(s) 2015
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DOI: 10.1177/0025802415591200

and review of literature msl.sagepub.com

Abhishek Yadav1, Md Shadab Raheel2, Lohith Kumar R3,

Sunil Kumar Sharma2 and Hemant Kanwar2

Abstract
Cut-throat wounds are a well-recognized method of homicide, are less commonly used in suicides and are rarely
accidental. The forensic pathologist has a very challenging and important task when commenting on the manner of
infliction of such wounds when such a case is presented with no proper history or witnesses. We present two cases of
cut-throat wounds, one suicide and one homicide, to show the differences between the pattern of wounds. We highlight
the differences between the two cases in relation to other external injuries, the circumstances in which the bodies were
found and other factors. We intend to update the literature regarding this topic in reference to our cases. We also hope
that our presentation will be beneficial to doctors performing autopsies on such cases, so as to distinguish the manner of
cut-throat wounds in equivocal cases of death.

Keywords
Cut-throat wounds, equivocal deaths, suicide, homicide, forensic medicine, multiple death investigations

Introduction and the case was treated as an unknown body.

Forensic pathologists often encounter cases of cut-
throat wounds where they are expected to comment
on the manner of homicide or suicide. When circum-
stances or witnesses in these cases are not reliable, the
police and investigating authorities look to the aut-
opsy surgeon to give them insight into the investiga-
tion. So, the autopsy surgeon should have a deep
understanding of this type of injury in order to lead
the investigation in the right direction. We present
two cases of cut-throat injury. The first case was of
homicide with no witnesses, and the body was found
in a deserted place. The second case was allegedly
suicide, but the police were suspicious of the circum-
stances and the statement of the witnesses. The
authors aim to highlight the differences in the pattern
of cut-throat wounds in homicide and suicide using
these two cases as illustrations. The case of suicide is
reported, as cutting the throat is a less commonly used
method for suicide.
Case 1
History
The deceased was found dead in a park at about
06:45 am. There were no witnessesDownloaded
or police history,
from msl.sagepub.com at Gazi University on February 18, 2016
The body was later identified, and it was found that
the person lived away from his home with no contact
with his family. He was well known as a bad charac-
ter, and was involved in various criminal activities.
Autopsy findings
External general appearance. The dead body of a well-
built adult male wearing shirt, jeans and shorts was
wrapped in body bag. Blood stains were present on
the clothes. The arms of the shirt were soaked in clotted
blood. Cut marks were present on the back of the right
side of the shirt collar and on the left side of the collar.
Clotted blood was present over both forearms and
hands. Mud was present on the jeans.
1
AIIMS, New Delhi Department of Forensic Medicine and Toxicology,
All India Institute of Medical Sciences (AIIMS), New Delhi, India
2
VMMC & Safdarjung Hospital, New Delhi, India
3
Kodagu Institute of Medical Sciences, Department of Forensic
Medicine and Toxicology, Karnataka, India
Corresponding author:
Abhishek Yadav, New Delhi Department of Forensic Medicine and
Toxicology, All India Institute of Medical Sciences (AIIMS), New Delhi,
110029 India.
Email: drayad_in@yahoo.com
54 Medicine, Science and the Law 56(1)

Figure 1. Case 1, neck wound on right side. Figure 2. Case 1, neck wound on right side.

The conjunctivae were normal. The natural orifices

also did not have any abnormal findings. Hypostasis
was present over the back, except over pressure areas.
Rigor mortis was passed off. Decomposition changes
were present corresponding to the time of discovery of
the body.
.
External injuries
1. An incised wound of size 20  10  5 cm was pre-
sent over the right side of the neck. The wound
started from 2 cm to the left of the midline at the
front of the neck below thyroid cartilage, going
obliquely upwards and backwards on the right
side of the neck, with the upper end ending at
the midline on the back of the right side, with
tailing (Figures 1 and 2). The margins of the
wound were blood stained. The wound was asso- Figure 3. Case 1, neck wound on left side.
ciated with cutting of skin, subcutaneous tissue,
sternocleidomastoid and other underlying mus-
cles, carotid artery, trachea, jugular vein and 4. An incised wound of size 4  0.3  0.2 cm was pre-
esophagus, and made an incision on the cervical sent horizontally over the left forehead 2.5 cm
vertebra at the level of C5, on the right side of above the left eyebrow 2.5 cm from the midline,
the neck. with blood-stained margins.
2. An incised wound of size 14  9  6 cm was pre- 5. A superficial incised wound of size 14  0.1 cm was
sent over the left side of the neck. The wound present vertically over the left side of the face and
started from the midline at the front of the neck forehead. The upper end started just below the
2.5 cm above the lower end of injury 1, going obli- hairline and the lower end touched the angle of
quely upwards and backwards on the left side of the mandible, with blood-stained margins.
the neck with the upper end ending at the midline 6. A superficial incised wound of size 16  0.1 cm was
on the back of the left side with tailing, 3 cm above present vertically over the left side the face and
the upper end of injury 2 (Figure 3). The margins forehead, parallel and 2.5 cm medial to injury
of the wound were blood stained. The wound was no. 5. The upper end started just below the hair-
associated with cutting of skin, subcutaneous line, and the lower end went towards the chin in a
tissue, sternocleidomastoid and other underlying curved manner and ended 5 cm from the midline,
muscles, carotid artery and jugular vein, and with blood-stained margins.
made an incision on the cervical vertebra at the 7. Multiple incised wounds were present over both
level of C4, on the left side of the neck. Injuries palms of the hands, ranging in size from
1 and 2 were separated only by a tag of tissue in 0.8  0.2  0.1 cm to 3  1  0.2 cm.
both anterior and posterior aspects. 8. The right forehead, the back of the right forearm,
3. Multiple superficial incised wounds were present the back of the left forearm and the anterior aspect
along the upper and lower ends of injuries 1 and 2 of the left middle leg each had a single incised
parallel to their direction. wound.
Downloaded from msl.sagepub.com at Gazi University on February 18, 2016
Yadav et al. 55

9. Reddish abrasions were present over the lateral

aspect of the left knee joint, the medial aspect of
the left knee and the left shoulder tip.

Internal examination. The neck structures were as

described above in external injuries. The lungs,
brain, liver, spleen and kidneys were pale. The stom-
ach contained about 150 ml of semi-digested food
material with congested mucosal walls. Other body
structures had no significant findings.

Case 2
History Figure 4. Case 2, old healed incised wound over right wrist.
The patient was admitted to hospital with a suicidal
cut-throat injury. The deceased came from Jalpaiguri,
west Bengal, and had come to New Delhi with seven
other people, through a contractor, to work as a farm
laborer in the neighboring states of New Delhi. He
had arrived the evening before the day of the incident,
and had spent the night at the work contractor’s tran-
sit accommodation along with other colleagues. They
woke up in the morning and were watching TV when
the deceased suddenly went to the kitchen and, after a
few minutes, came back bleeding from an injury to his
neck. His colleagues immediately tried to stop the
bleeding by wrapping a towel around the wound,
and brought him to the hospital. The police crime
team recovered a blood-stained kitchen knife from
the crime scene. A blood-soaked towel, which was
used by the roommates to clean the blood on the
floor, was also recovered.

Autopsy findings
External general appearance. The dead body was of an
average-built adult male with a blood-stained surgi-
cal dressing present over the neck. The conjunctivae
were normal. The natural orifices did not have any
abnormal findings. The scar of a healed incised
wound was present over the front of the right wrist
(Figure 4). Figure 5. Case 2, neck wound on anterior aspect of neck.

External injuries

1. An incised wound of size 10.5  4 cm was present
over the front of the neck across the midline. The
wound was horizontally placed above the thyroid
cartilage 6 cm below the extended chin and 8 cm
above the sternal notch in the midline with no
tailing on either side (Figure 5). The margins of
the wound were blood stained. The wound was
associated with cutting of skin, subcutaneous
tissue, underlying muscles, trachea and the left
anterior jugular vein.
2. A superficial incised wound of size 3.5  1 cm was
present horizontally over the right side of the neck
Downloaded from msl.sagepub.com at Gazi University on February 18, 2016
with blood-stained margins, 1 cm right of the mid-
line and 0.5 cm below injury 1 (Figure 6).
3. A superficial incised wound of size 3  0.5 cm was
present horizontally over the right side of the neck
with blood-stained margins, 1.5 cm lateral to the
midline and 0.8 cm below and parallel to injury 1.
4. A superficial incised wound of size 3.5  0.5 cm
was present horizontally over the left side of the
neck with blood-stained margins, 1 cm below
injury no. 1 and 1.5 cm lateral to the midline.
5. A superficial incised wound of size 6  0.5 cm was
present horizontally over the left forearm with
56
walls were normal. Other body structures had no sig-
nificant findings.
Discussion
Figure 6. Case 2, hesitation wounds associated with neck
wound.
Figure 7. Case 2, hesitation wounds over left wrist.
blood-stained margins, 6 cm above the left wrist
joint (Figure 7).
6. Multiple horizontally placed superficial incised
wounds were present just above injury 5.
Internal examination. The neck structures were as
described above in external injuries. The lungs,
brain, spleen and kidneys were pale. The liver was
enlarged and pale. The stomach contained about
100 ml of semi-digested food materialDownloaded
and from
mucosal
msl.sagepub.com at Gazi University on February 18, 2016
Medicine, Science and the Law 56(1)
We will now analyze the differences in suicide and
homicide cut-throat wounds by way of illustration
from our cases. The forensic pathologist should care-
fully examine such types of injuries along with the
circumstantial evidence, and should theorize about
the manner of injury keeping in view all aspects of
the case.
Suicide wounds by knife or sharp cutting weapon
are usually on the neck, chest and wrists. In a right-
handed person, suicide cut-throat wounds normally
begin high on the left side of the neck below the
angle of the mandible and travel obliquely downwards
to the front of the neck, ending at the right side of the
neck. In a left-handed person the directions are
respectively changed. There are other self-inflicted
wounds on accessible parts of the body. The wounds
are deeper at their start and become shallow during
their course, ending with tailing.1–4 However, Knight
and Saukko5 dispute this finding and note that many
cut-throat wounds are horizontal with no variation in
depth. Injury 1 in Case 2, which was also the fatal
injury, was in accordance with the observation made
by Knight and Saukko.
Homicide wounds are deeper, extending to the ver-
tebra due to the excessive use of force by the assail-
ant.2 This was observed in injuries 1 and 2 of Case 1,
where both wounds extended to vertebrae with cut
marks on their body. The extent of force, reflecting
the manner of assault, is also demonstrated by the
multiple injuries to the body (injuries 4, 8, 9).
Injuries 5 and 6 show that the assailants attempted
to cut the face of the victim to conceal his identity.
Suicide cut-throat wounds are placed at a higher
level (above the thyroid cartilage), while homicide
wounds are present at a lower level (below the thyroid
cartilage).1–5 This difference is clearly demonstrated
in injury 1 in both cases.
Suicide wounds are accompanied by hesitation
cuts, which are superficial and adjoining the fatal
wound, but this is not found in homicide cases.1–5
Injuries 2, 3 and 5 in Case 2 are indicative of this.
Also, injury 5 shows an attempt of the deceased to
cut his wrist, and injury 6 shows hesitation cuts in
the wrist attempt. Defense wounds are present in
homicide cases instead of hesitation cuts,1,2,4 which
is shown in injury 7 in Case 1.
In our homicide case both the carotids were cut,
along with the jugular veins. The cutting of the vessels
led to a large amount of blood loss, causing quick
death. The arms of the victim’s shirt were soaked in
blood, with clotted blood present all over the arms
and hands. This could be due to a number of reasons,
one of which may be that the victim desperately tried
to control the bleeding from the carotids. The carotid
Yadav et al.
arteries in suicide wounds are usually spared, as they
are drawn beneath the sternomastoid muscles due to
hyperextension of neck by the victim.1,2,4,5 Case 2 was
associated with the cutting of the left anterior jugular
vein, leading to blood loss but not as abruptly as in
Case 1, resulting in a survival time of about 5 h in
Case 2. In Case 2, the time from the injury being
noticed by colleagues and the victim arriving at the
hospital was about 1 h, and the victim survived for 4 h
in the hospital as per death summary.
Cuts on clothing are present in cases of homicide
but not in the majority of cases of suicide, as the
victim removes clothing to expose a clear field of the
neck.2–5 The homicide victim’s shirt had cut marks
along on both sides of the shirt collar corresponding
to the injuries, whereas the suicide victim was not
wearing a shirt at the time of the incident.
The presence of old injuries indicates previous sui-
cide attempts. Case 2 had an old healed incised-
looking injury on the right wrist, which points
towards a previous suicide attempt.
Due to cadaveric spasm, the weapon is sometimes
firmly grasped by the victim in suicide cases but not so
in homicide cases. Instead, foreign materials such as
hairs, fibers, buttons, etc., may be found grasped in
the hands in homicide cases.1,2,4 A weapon was not
recovered in Case 1, but in Case 2 the weapon, a kit-
chen knife, was found at the crime scene.
In suicide cases, the body is usually found in a
closed room with minimal disturbance of the crime
scene, whereas there is considerable disturbance
found in homicide cases. A suicide note will support
the suicidal nature of the act.2,4 Previously reported
cases of suicide cut-throat injury had similar wound
features as seen in our Case 2.5,6
We have now analyzed the differences in suicide
and homicide cut-throat wounds by way of
Downloaded from msl.sagepub.com at Gazi University on February 18, 2016
57
illustration from our cases. The forensic pathologist
should carefully examine such types of injuries along
with the circumstantial evidence, and should theorize
about the manner of injury keeping in view all aspects
of the case.
Funding
This research received no specific grant from any funding
agency in the public, commercial or not-for-profit sectors.
Declaration of conflicting interests
None declared.
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