ORIGINAL ARTICLE Putrefaction and Wound Dehiscence A Potentially Confusing Postmortem Phenomenon Roger W. Byard, MBBS, MD,* Axel Gehl, MD,† Sven Anders, MD,† and Michael Tsokos, MD† Abstract: The decomposed body of a 49-year-old man was found at his home address. At autopsy, 3 incised wounds of the lower abdomen and groins were identified, raising the possibility of some form of inflicted injury. Further dissection revealed that the wounds were healing surgical incisions that had been forced open by putre- factive tissue breakdown, swelling, and gas formation. Death was due to ischemic heart disease. Putrefaction is a common problem encountered in forensic practice that may result in considerable distortion and modification of tissues. Unusual skin lesions caused by the disruption and dehiscence of healing surgical wounds may be created by decomposition. This possibility should be considered when symmetrical, cleanly incised wounds are identified. Key Words: incised wound, mutilation, postmortem change, putrefaction, surgery (Am J Forensic Med Pathol 2006;27: 61– 63) P utrefaction causes a number of difficulties with postmor- tem examinations. Cases are often technically difficult to handle, and interpretation of findings is made more difficult by loss and modification of tissues. Occasionally, artifacts of putrefaction occur which either raise the possibility or dis- guise the presence of injuries. The following case illustrates an unusual effect of postmortem tissue decomposition on recent surgical incisions. CASE REPORT A 49-year-old male was found deceased in bed at his home address, having been last seen 10 days previously. The body was clothed in underpants and socks. As there was no scene disturbance or evidence of a break-in, the body was removed to the city mortuary located at the Institute for Forensic Medicine in Hamburg for further examination. Ex- ternal examination revealed the body of a putrefied, adult, white male. On closer examination of the anterior abdominal wall, a gaping, central, midline, abdominal, incised wound (110  210 mm), and 2 similar symmetrical, gaping, incised wounds of the right and left groins were identified (35  85 mm; 40  100 mm, respectively) (Figs. 1 and 2). These initially appeared to be possible stab wounds. The wounds were morphologically similar, with clean incised edges and no significant hemorrhage (Fig. 2). The appearances were, therefore, more those of postmortem inju- ries, raising the possibility of ritual mutilation, although the possibility of antemortem injury could not be excluded until careful dissection of the wounds with an examination of the abdominal cavity had been undertaken. Subsequent exploration of the wounds, however, re- vealed separation of the skin and subcutaneous tissues, with very sparse fragments of suture material within underlying, intact muscle layers. The wounds did not communicate with the abdominal cavity or involve underlying vessels. There were no injuries to femoral vessels, aorta, the abdominal cavity, or contained viscera. Once the abdominal organs had been removed, a recent, intact prosthetic aortobifemoral by- pass graft was located (Fig. 3). The remainder of the autopsy revealed marked coronary artery atherosclerosis, with a re- cent myocardial infarct of the anterior wall of the left ven- tricle. No other significant diseases were found that could have caused or contributed to death, and there was no evi- dence of trauma. Toxicologic studies were not undertaken. Death was, therefore, attributed to an acute myocar- dial infarct complicating coronary artery atherosclerosis. The abdominal and groin wounds were caused by separa- tion of sutured surgical sites overlying a recent aortob- ifemoral graft. Subsequent inquiry revealed that the de- ceased had undergone bypass surgery approximately 4 to 6 weeks prior to death. DISCUSSION Forensic examination of individuals found unexpect- edly dead is required for a variety of reasons, not the least of which is the documentation or exclusion of injuries, particularly due to inflicted trauma, that may have caused or contributed to the terminal episode. In the reported case an unusual constellation of wounds was discovered at autopsy in the lower trunk. The cleanly incised edges of the wounds left no doubt that they had been created by cutting of the skin and subcutaneous tissues with a sharp Manuscript received December 9, 2004; accepted July 8, 2005. From the *Forensic Science Centre and University of Adelaide, Adelaide, Australia; and the †Institute of Legal Medicine, University of Hamburg, Hamburg, Germany. Reprints: Roger W. Byard, Forensic Science Centre, 21 Divett Place, Adelaide 5000, Australia. E-mail: byard.roger@saugov.sa.gov.au. Copyright © 2006 by Lippincott Williams & Wilkins ISSN: 0195-7910/06/2701-0061 DOI: 10.1097/01.paf.0000202708.49030.03 The American Journal of Forensic Medicine and Pathology • Volume 27, Number 1, March 2006 61