Ligature strangulation

Dr. Muditha Vidanapathirana

MBBS, DLM, MD, MA, MFFLM (UK)
Senior Lecturer.
Department of Forensic Medicine
FOMS, USJP

Definition
Constriction of
the neck by a
ligature,
Where
constricting force
is other than the
body weight.

Traditional names
1. Garroting- Eg. In punishment killing or
violent robbing.
2. Judicial execution in Spain.
3. Catalan garrote- Spike enter the neck,
causing injuries to medulla and spinal
cord.
4. Lathi- In India.

Questions
1. Appearance and significance of
marks on neck in ligature
strangulation.
2. Autopsy features of ligature
strangulation.
3. Difference between low point
suspension and ligature
strangulation.

Aims of investigation
Cause of death have to differentiate from hanging,
specially low point suspension.

Mechanisms of death,
Manner of death,

Circumstances
1. Homicidal- LS

Almost all cases.

Usually associated with sexual assaults
eg. Rape-murders.
So the incidence of ligature strangulation
is high among females than males.

2. Suicidal-LS

Rare.
Can tie a ligature with at least one knot,
before loosing consciousness (ie. Within
10-15 seconds).
Some times several turns around neck
with out knots.
Some times windlass method. Put a
noose with a fixed knot around the neck,
and then put a stick between the noose
and the neck, which is turned several
times to constrict the neck. When he
looses the consciousness, the pressure
will not released due to the stick, which

3. Accidental LS
Clothes used around neck with
shalvars, Ties or scarf can entangle
with a turning machine. Eg.
Unprotected fans, wheel of a motor
bike, or industrial machines.

Mechanisms of death

1. Occlusion of veins and carotid arteries,

2. Occlusion of air ways.
3. Heart failure due to CCI (cumulative cardiac
insult) - resulting in cerebral hypoxia.
Ligature obstruct both jugular veins and
carotid arteries, but cannot obstruct vertebral
arteries . Therefore blood continues to
perfuse to head more than draining out by
small vertebral venous plexus. So the venous
pressure in the head increases, resulting
asphyxial signs above a tide mark in neck.
Not like in manual strangulation, Ligature will
maintain the obstruction more than 4
minutes resulting death due to occlusion of
veins, arteries or airways.

Postmortem investigation
Authority- Magistrate order.
History Of the incident
After the incident.
Before the incident- past medical
history- psychiatric illness, previous
suicidal attempts.
Visit to the scene Almost always a third person is
involved. So take photographs, collect

Autopsy
Identification
by relatives or friends
Preliminary investigations
Photographs
X-rays- of neck AP and lateral,
Trace evidences- nail clippings or
scrapings, hair, fibres, swabs from
oral, anal and vaginal.
Clothing examination.
External examination

External examination

General
Identification features- if an unidentified
body.
Post mortem changes to asses time
since death. Eg. Cooling, rigor mortis,
putrefaction. Etc.
Hypostasis not in extremities as in
hanging.
Specific- 3 aspects.
1. Features due to mechanism of death

Features due to Mechanism of death

A. Asphyxial- Vessels obstruction
(jugular and carotids) and CCI are the
common mechanisms. Which can
cause raised venous pressure in the
head resulting asphyxial sings above
a tide mark in neck.
Petechiae,
bluish discoloration,
congestion and oedema,
confluent haemorrhages.

2. Features due to agent (ligature

and ligature mark)
A. Describe the ligature Type- soft or hard, patented or not, broad
or narrow,
Usually use a ligature available at the
locality. Eg. Brassier strap, towel, coir
ropes etc.
Special techniques such as windlass etc.
Turns- single or multiple.
Knots- single or multiple or non.
Remove the ligature by cutting it sparing the
knot for future references.
B. Then describe the ligature mark.

 Ligature mark description,

Ligature mark depends on, type of
ligature, direction of application,
force used, duration of constriction.
Some times no or minimal ligature
mark, if soft ligature (eg. Clothes) x
short duration ( eg. Removed soon
after death).

Ligature mark description.

1. Site- on or below the laryngeal cartilage.
2. Size length- right round the neck.
Width,
Depth- equal right round.
3. Shape Patented- can compare with the ligature
when it is recovered.
Initially yellow, then becomes brown with
drying.
One or more turns can be present.
One or more knot marks can be present.

 4. Defense scratches vertical, multiple , parallel, nail

abrasion.
5. Differentiation from hanging Ligature strangulation mark usually
not mimic hanging, except strangle
with ligature and then pull along
the ground from the free end of the
ligature resulting an inverted V
appearance at the knot mark.

 6. But hanging mark (specially complete

suspension with slip knot or low level
suspension) can mimic ligature
strangulation. So the differentiation is
done by following features of ligature
strangulation.
On or below the laryngeal cartilage,
Horizontal (not raise toward the knot)
No gap under the knot. Runs right
round. (except if, hair or clothing
intervene the ligature and neck)
No inverted V appearance at the knot
mark. Can have a cross over point.
Depth is equal right round the neck.

7. But some times, if very low level

suspension with sliding knot can mimic
ligature strangulation.

Eg. Runs right round, with out gap or

inverted V appearance under the knot,
and can be found on or below the larynx
with asphyxial features.hypostasis may
not found in extremities in complete
hanging. Deepest on the opposite side to
the knot is also can be negative if a soft
ligature is used.
In such situations, has to be used other
evidences such as,
i. scene finding- in masochistic
practices of accidental hanging, in

8. Differential diagnosis, exclusion.

Fat freezing at neck skin creases

in obese or infants after
refrigeration.
Tight collar with putrefaction.
Elderly with heart failureasphyxial features with
prominent skin creases of the
neck.

 9. Red margins on either side of

the ligature.
These are due to
displacement of blood
beneath the ligature but not
considered as a vital
reaction.
10. Red haemorrhages can be
found on the ligature mark.

 11. Not necessarily indicate AM

ligature strangulation mark.
Even strangled 2 hours after
death, can receive same
features as AM.
12. No other injuries usually
found on neck.
If found, DDs,
Self inflicted defence
scratches,

3. Features due to
circumstances
In suicidal ligature strangulationMay be able to put at least one
knot before loosing
consciousness. If multiple
knots, more favor of homicidal.
Repeated encircling with or
with out knots.
Windlass method,
Elastic ligatures, eg.
Tourniquet.
Plastic lock tie-.

 If accidental ligature
strangulationConstriction by clothes
around neck when they
entangled with turning
machines or fans or wheels.
If homicidal- LS
Usually with sexual assault.
Genital and hymeneal
injuries, bite marks etc can
present.
Evidence of struggling on

Internal examination

Features due to Mechanism of death

Asphyxial features- petechiae, bluish discoloration,
congestion and oedema, haemorrhages on epiglottis.
Features due to agent (ligature)
Anterior compartment- sub-cutaneous tissues and
muscles have minimal haemorrhages (20% cases).
Glands and common carotid artery can get injured
rarely.
Middle compartment- laryngeal fractures- depends on
level of constriction thyroid superior horn fractures,
cricoids fractures,
hyoid fractures.
Oesophagus usually spared.
Posterior compartment- usually spared.
Features due to circumstances Genital injuries and bodily injuries in sexual assault.

Lab investigations
1. Blood for toxicology- alcohol,
drugs, poisons
2. Nail clippings or scrapings.
3. Hair- if clenched in hands with
cadavaric spasms.
4. Ligature mark histology.