The widely practiced conventional methods for skin incision to be made during autopsy process have been discussed in books devoted to forensic pathology. But while adopting one of the conventional methods of skin incision, separate incisions are invariably required for the assessment of soft tissue injury on the back and to open the spinal canal during autopsy. Further additional confirmatory (for differentiating bruise from hypostasis) or releasing incisions are required for complete exposure of the front of the neck (i.e., along the inferior border of the lower jaw and over the collar bones) and pelvic cavity (i.e., along the course of inguinal ligaments). On reconstitution of the dead body, sutured conventional incision on the front aspect of the body along with additional incisions leads to the visible artifacts over the skin surface, i.e., apparent disfigurement (mutilation) of the dead body. Therefore, these incisions are cosmetically ineffective and scare the legal heirs of the dead body.
Our proposed method for skin incision provides complete exposure of the whole circumference of the neck, thorax, and abdomen with single incision line; thereby, the operational area for autopsy assessment is almost 100%. This aspect of our incision method is in corroboration with the use of fourth incision (Patowary 2010).
On reconstitution of the dead body after autopsy with any of conventional skin incisions, there is seepage of extravasated body fluids which leads to inconvenience during transportation to the attendants of the deceased. Adoption of the fourth incision method decreases the chance of seepage to almost nil as the abdominal cavity is closed first by stitching the rectus and then the flap of skin is replaced back covering it completely (Patowary 2010).
In our method of skin incision, seepage is nil too. However, there is no need to stitch the muscular flap of the anterior abdominal wall due to double breast advantage as the free end of the muscular flap is reflected back opposite to the line of skin closure.
In conventional methods, stitches made on the body for closing are seen on the front aspect of the body whereas in consonance with the fourth incision in our method too, the stitches except in the front of the shoulder and inguinal region are not apparent from the front or back view of the dead body.
The fourth incision consumes time, 10 min more for opening the body and 15 min more for closing, than in “I-shaped incision” (Patowary 2010).
In contrast, our method of skin incision is shorter in length that is equal to the length of the torso of the deceased as compared to fourth incision, and further, there is no need to stitch the muscular flap separately. Thereby, the extra time taken by fourth incision is almost curtailed by our method.
The current work presents a simple procedure of skin incision for the assessment of the neck, the front as well as back of the chest, and the abdomen and discusses its advantages on the basis of existing methodologies. The technique preserves the whole flap on the front and back of the neck, chest, and abdomen, and it does not interfere with the rest of the autopsy procedure. After dissection, reassessment of the wound tract in stab and firearm injury is easier and is convenient for surgical death cases too, as the proposed skin incision is not interfering with iatrogenic surgical incisions.
Our method is friendly for autopsy surgeons and legal heirs, as it is cosmetically effective and advocates single incision. Its routine application is both feasible and useful for autopsy on female corpse, cases of death due to custodial torture, trauma on back, surgical death cases, or fatal pressure over the neck. However, any new scientific method needs its unbiased validation of its procedure and outcome in light of the different aspects of doers and beneficiaries.
The current study is based on a single case which may serve as a limitation to extrapolate findings to different settings. A validity study is being planned in the near future to establish the advantages of the new incision.