Critical Evaluation of Metallization in Electric Injury Sigitas Laima, PhD,*† Jana Bytautaite, MSc,*† Sigitas Chmieliauskas, MSc,*† Dmitrij Fomin, MSc,*† Algimantas Jasulaitis, PhD,* Arturas Jukna, PhD,‡ Sandra Mazeikiene, MSc,*† and Jurgita Stasiuniene, PhD* Abstract: The article presents 3 forensic medicine cases in the field of electric injury. In addition to traditional findings in electric injury (electric mark and histological findings), the forensic medicine experts in Lithuania also perform an atomic absorption spectrometry analysis. This method confirms the effects of electric current to the body through the electric con- ductor. Typical macroscopic finding in the skin is electric mark. Histolog- ically, the damaged skin possesses characteristic features of thermal burns. The atomic absorption spectroscopy analysis identifies traces of metal par- ticles devolved from the electrical conductor, which confirms a premortal contact with it. In one of our presented cases, the metallization was nega- tive, although there were obvious data of electric current effect. This shows that it is not always worth to rely on the method of atomic absorption spec- trometry analysis recognized worldwide in forensic medicine. The determi- nation of electrical injury diagnosis requires a critical and comprehensive assessment of all the available data and laboratory tests. Key Words: forensic medicine, electric mark, electrocution, metallization, metal traces (Am J Forensic Med Pathol 2017;00: 00–00) D eaths due to electric current are being identified on the basis of anamnesis, autopsy findings, histology, and criminalistics examinations. Effects of electric current in the body are local and general. In cases of fatal electric injury, only local effect of electric current is expressed—the electric mark. 1,2 During the internal body examination, the following signs of sudden death are usually observed: petechial hemorrhages on the epicardium and pleura, venous plethora of the internal organs, and postmortem fluidity of the blood. 3–6 It is therefore necessary to focus on the external body examination searching for morphological effects of electric current—electric marks. 7 To confirm the cause of death, the skin pieces from the site of electric mark are sent for histological and criminalistics examination. 8 However, can these tests be always reliable? We will introduce 3 forensic medicine cases where the results of atomic absorption spectrometry analysis differ. The au- topsies were performed in the State Forensic Medicine Service, Vilnius Department. Electricity and Identification of Its Effects on Human Body The human body is an electrically conductive matrix in which every tissue and organ has different electric conductivity. The severity of the injury depends on the voltage of the source and the resistance of the victim, the pathway it follows through the body, and the duration of the contact with the source of the cur- rent. 9 The lowest resistance is in the nerves, blood, mucous mem- branes, and muscle tissue. The most resistant tissues are the dry skin, tendons, fat, and bones. 10 The life-threatening electric cur- rent paths are hand-hand and hand-legs because, in these cases, the current flows through the vital organs such as the heart, lungs, or brain. The higher is the voltage and tissue resistance and the longer the tissue exposure to electric current, the greater is the thermal ef- fect on the tissue. Macroscopically, an electric mark resembles a skin burn with or without blistering, with the surrounding red demarcated zone. In a long-term effect of electric current, the tissue charring begins, forming a black ash-colored, crater-shaped wound—Joules burn. 11 Microscopically, the epidermis is dissected from the dermis, vacuolization—small vesicle formation between the epidermal cells resembling “Swiss cheese” appearance, and elongated pyk- notic nuclei located along the basement membrane are seen. 12 The evidence strongly suggests that epidermal nuclear elongation in electrical and burn injuries is due to dermal expansion by heat. 13 Meanwhile, other authors revealed that the microscopic changes of thermal injury are significantly more frequent in elec- tric lesions than in flame burns or traffic accidents. 14 A specific sign of electric injury is metallization—the process of transferring of metal particles from electrical conductor into the skin. In foren- sics, it is determined by atomic absorption spectrometry analysis. 8 Experiments have shown that atomic absorption spectrometry analysis may identify certain metal particle deposition in the skin. The method is also useful in determining the time of electrical exposure, when the exact type of metal touching the skin is known. 8,15 The background traces of metals naturally contained in the skin are not significantly affected by the current causing electric injuries and do not interfere in determination of external metal deposition into the electric marks from the wire inflicting the fatal injury. 7 Qualitative Analysis of Metal Traces The method of atomic absorption spectroscopy to detect metal traces in electric marks was experimentally proven in Lithuania in 2006 and is an established method in Lithuanian fo- rensic medicine practice. The metal depositions from skin pieces with electrical mark and control skin pieces are extracted in 5% nitric acid solution. The extracts are analyzed by application of atomic absorption spectrometry estimating and comparing the op- tical density of metal particles in both groups. The presence of metal traces is confirmed when the difference between injured skin sample extract and control sample extract optical densities is statistically significant (corresponding P < 0.05). 7 Case Reports Accidental Electrocution in the Bathtub A woman, 59 years old, was found dead lying naked in her bathtub. At the crime scene, a shiny, metallic showerhead was near the body. During scene investigation, defective wire insulation in Manuscript received August 31, 2016; accepted June 6, 2017. From the *Faculty of Medicine, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, Vilnius; †State Forensic Medicine Service; and ‡Faculty of Fundamental Sciences, Department of Physics, Vilnius Gediminas Technical University, Vilnius, Lithuania. The authors report no conflict of interest. Reprints: Sigitas Laima, PhD, Faculty of Medicine, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, M.K. Ciurlionio St 21, LT-03101 Vilnius, Lithuania. E-mail: sigitaslaima@gmail.com. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0195-7910/17/0000–0000 DOI: 10.1097/PAF.0000000000000335 CASE REPORT Am J Forensic Med Pathol • Volume 00, Number 00, Month 2017 www.amjforensicmedicine.com 1 Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.