Suicidal and homicidal sharp force injury: a 5-year retrospective comparative study of hesitation marks and defense wounds

In sharp force injury cases, the presence of hesitation marks or defense wounds figures among useful characteristics in the distinction of suicide and homicide. However, there are very few systematic comparative studies of hesitation marks and defense wounds in the forensic literature. This study was thus undertaken to systematically compare features of hesitation marks and defense wounds, with a particular emphasis on dispersion patterns. Over a 5-year period, all suicidal and homicidal sharp force cases were retrospectively reviewed for hesitation marks and defense wounds. A total of 58 suicides (7 women; 51 men) and 149 homicides (59 women; 60 men) were found, of which 74% (n = 43) were positive for hesitation marks and 61% (n = 91) for defense wounds. On the upper limbs, hesitations marks were more often observed on the anterior aspect of the limb, while defense wounds were equally distributed on the anterior and posterior aspect. For hand lesions, hesitation marks were generally located on one side only, while defense wounds more commonly involved both sides. No left or right predominance was observed in hesitations marks or defense wounds. Defense wounds were more widely distributed on the upper limbs than hesitation marks.