Introduction

General meaning
It is a mark left by a healed wound, sore, or burn or
a lasting aftereffect of trouble, especially a lasting psychological injuryresulting f
rom suffering or trauma or
any blemish remaining as a trace of or resulting from injury or use.

Scars are often the result of past wounds or injuries that may have required hospital treatment
and this is a good place to start for the pathologist who wants to make a positive identification.

Hospitals keep detailed records of all injuries and especially in the case of injuries that will have
required an operation of sorts to rectify the problem. These operations may have been small -
keyhole surgery - or major invasive surgery but they will have all left their own tell tale marks:
i.e. scars.

In a patient's medical files there will often be a detailed sketch of the anatomy and on it will be
marked out areas of the body that were operated upon and this is a good place to start when it
comes to identifying scars.
Scars

The positions, sizes and shapes of scars, tattoo marks, fracture and deformities are helpful. A fire
at the central apartment building in a city recently completely gutted the third floor and heavily
damaged the first and second floors of the structure. An investigation was conducted by the
police department and a member of the fire brigade office to ascertain its cause and account for
all building occupants. It revealed the fire had originated in apartment 42 and spread throughout
the entire third floor. Careless smoking was the probable cause of the blaze. During their search
of apartment 42, badly charred human remains were found frozen into the debris. These were
chipped free and removed to the mortuary where a post-mortem was conducted. The corpse was
so severely charred that identification could not be made by physical appearance, fingerprints or
dentures. All occupants were accounted for except one, a known alcoholic approximately 50
years old, who lived in apartment 30 on the third floor and had been seen coming home in an
inebriated state about one hour before the fire was reported. It was surmised that the charred
remains were his. However, the things that could be established with certainty were: the body
was male, of the same height and was discovered in apartment 42not apartment 30. Although
this suspected victim was known to wander from apartment to apartment, further identity doubts
were formed when another occupant claimed to have seen him leave the building a short time
after the arrival of the fire department. The suspected victim has been known to wear a belt
decorated with a World War II medal, the finding of which would assist in identification. In an
attempt to locate the medal the pathologist X-rayed the corpse while the police searched the
debris. The medal was not found. The X-rays did, however, reveal that both ankles had
previously been fractured. The victim's hospital records revealed similar fractures, comparison of
the X-rays of the deceased with those on the hospital file were able to positively identify the
body of the suspected victim. (CH) 21.6.5 Professional Marks A photographer, a dyer, a painter,
a laboratory worker or a chemist will have stains on his person. A tailor, a draughtsman or a
petition writer will have stiffening on his hand. Professional marks reduce the number of
possible suspects. Professional dust carried by the deceased is also useful. A colliery worker
carries coal particles, a flour mill worker carries flour and so on. 21.6.6 Personal Articles The
personal articles: clothes, shoes, ornaments, a watch, a knife or a pen may carry the name of the
manufacturer, the repairer or of the supplier. The clothes may also carry laundry marks. The
shoes carry, in addition, the prints of the feet inside. These prints are compared with similar
prints in other pairs of shoes, found at the residence of the suspected victim. They may, thus,
help to identify the deceased.

What is scar

A scar or cicatrix is a fibrous tissue covered by epithelium formed as a result of healing process
of a wound. It is devoid of hair follicles, pigment and sweat glands. A known scar on a particular
part of a person's body may help in identification, though multiple scars are more convincing.
Scars being formed of fibrous tissue with less vascularity, resist decomposition and as such can
help in identification of grossly decomposed body. Probably, the best known instance of
identification by scar is the Crippen case of 1910 in which much forensic controversy was
generated over the distinction between a surgical scar and a skin crease on a piece of abdominal
wall. In any injury where the dermis has been entered, healing occurs by organization of blood
clot and/or granulation tissue thereby resulting in formation of scar. Injuries involving only
epidermis heal without any scar formation.

Examination of Scar

Scar must be examined under adequate lighting. The description should include: number, site,
size and shape, its particular location upon the body, fixed or free, smoothness or irregularity of
the surface, colour and the presence/absence of glistening and tenderness. The condition of the
ends (whether tapering or not) and the probable direction of original wound may be determined.
The application of heat, filtered ultraviolet light or surface friction are helpful in making faint
scars readily visible. A magnifying glass is very useful. Suspected scar in a dead body can be
proved by microscopy by examining for the presence/absence of elastic tissue which is absent in
a scar.
Nature or Position, Characters of Scar

A scar generally assumes the shape of the wound causing it. A scar resulting from an incised
wound (which has healed by primary union) is usually linear and straight. However, a scar
following an incised wound of axilla or upon the genitals, may be irregular on account of loose
folds of the skin and may also be smaller than the original wound.

Lacerated wounds result in broad and irregular scars.

Suppurated wounds also produce irrezular and large scars, which are attached to Ole deeper
tissues.

In a case of stab wound, depending upon the shape of the blade of the weapon, scar may be
elliptical, oval or irregularly shaped.

Large irregular scars accompanied often by keloid patches result from extensive burns and
scalds.

Scars resulting from bullet wounds are generally irregular, depressed and adherent to the
underlying tissues. (Occasionally, bullet-wound scar may become matter of controversy as
happened in 1989 over the identity of Nazi war prisoner Rudolf Hess, who was alleged to have
been an imposter because he had no scar from an old rifle bullet wound through the chest.)

Vaccination scars are circular or oval, flat or slightly depressed.

The old scars of wrist or throat-slashing indicate previous attempts at suicide.

Scar causing permanent disfiguration of head or face amounts to grievous hurt.

Scar causing contracture at or around a joint restricting the movements or functions of the joint
amounts to grievous hurt.

Scar over cornea amounts to grievous hurt by way of causing permanent (total or partial) loss
of vision.
 Scars at cubital fossa or dorsum of hand may indicate drug addiction.

Striae gravidarum indicate past or present pregnancy.

Age of the Scar

It is difficult to assess the exact age of a sc vary according to the nature are as it will wound, the ,
size and position of the presence or absence of sepsis, the method of healing and the vascularity
of the part. The latter factor is influenced by age, physical status and pathological conditions of
the blood vessels. Therefore, a medical witness must be careful in answering this question. The
age of the scar becomes materially important towards ascertaining the time elapsed since
infliction/sustaining of injury in an assault or otherwise.

A rough idea about the age of the scar may be gathered from the following:

An uninfected superficial cut (as for example, a shave-cut) usually heals with formation of a
scar by 5th or 6th day. In case of clean aseptic wound as produced by a surgical knife and heals
by first intention, the scar usually appears in a fortnight while in a suppurating wound, it may
take from two weeks to three months or more.

Freshly formed scar appears reddish or bluish but is tender and soft. The age of such a scar is
up to a couple of weeks.

As the vascularity diminishes, the scar becomes pale but is still tender and soft. The age is up to
a couple of months.

With age, the scar contracts but still little tender and soft. The age is between two to six
months.

As the scar further contracts, it becomes tough, white and glistening. The age probably is not
less than six months to an indefinite number of years.

Erasure/Disappearance of Scar

Scars resulting from wounds or skin diseases involving whole thickness of skin are always
permanent but superficial linear scars involving epidermis may disappear in a few years.
 A scar may be removed by plastic surgery or its shape and size may be altered by surgic,1
operation.

Tattooing or infliction of incisions on the scarred area to efface it, can sometimes be practiced.

Quality of Life and Scarring

Scars are an inevitable part of most peoples lives. There is nearly a person
on earth who does not have some type of scarring. Severe scarring though
affects individuals quality of life and often decreases their self image. Self
image is so much a part of persons happiness and success that medical
science has gone a long way to reduce the adverse effects of scarring no
matter how the scar occurred.

Uniqueness of Burn Scars

Burn scars are often very traumatic, disfiguring and they are the hardest to
treat through revision. When a person has significant scarring from burns
there is often associated trauma that takes priority prior to addressing the
issue of scarring. Life saving measures, infections and other complications
take persistent over issues that will arise from burn scars.
Pain management is very vital because the pain from burn is one of the
most excruciating types of pain one can bear. Where healthy skin and
burned skin intersect pain can be a life time issue. Psychological issues
such as severe depression are a compounding factor for people disfigured
from burns. Scar tissue does not maintain the suppleness or laxity of
healthy skin. As scars mature the fibrotic tissue composing it shrink and
becomes more rigid. The location of such scars near joints of the hands,
feet, limbs and neck can adversely affect the mobility of the joints.

Another issue with burn scarring is the need for skin grafting and the
associated healing and scarring with those procedures. In addition burn
scars because of the severity often are comprised of a combination of
types of scars. This includes:
 Hypertrophic scarring
Hypotrophic scarring
Hyper-pigmentation scarring
Keloid scarring

Crippen Case (CCC 1910)

In the trial of Dr Crippen for the murder of Cora Crippen, the presence of a four-inch scar on a
piece of abdominal skin was an important factor in identifi-cation of the remains as those of the
missing woman. It was proved in evidence that Mrs. Crippen hd had a an operation in that part
just before the marriage.

Medicolegal Importance

(1) They form important marks for identification of a person.

(2) The shape of the it may indicate the nature of weapon or agent that caused the injury.

(3) The age of it is important in a criminal offense, if the age of a wound corresponds with the
date of the attack it may have value as circumstantial evidence.

(4) Linea albicantes may indicate previous pregnancy.

(5) If a person is disfigured due to scars, it becomes a grievous hurt.

(6) Scar causing contracture at or around a joint restricting movement or functions of the joint
becomes grievous hurt.

(7) The accused may attribute scars of wounds to disease or therapeutic procedures.

(8) To charge an enemy with assault, a person may claim that scars due to disease are those of
wounds.
Burn scar