Unusual ligature mark after strangulation and skin maceration

Strangulation by ligature is often homicidal and is mainly diag- nosed through the detection of a ligature mark on the neck. We describe the unusual appearance of a ligature mark in a woman who was strangled and thrown into a river, where she lay for one month. On her neck, there was an irregular horizontal tear, asso- ciated with superficial ecchymosis and deep structures’ haemor- rhage. We made a comparison with literature cases of unusual features of the ligature mark. The ligature mark appearance can be influenced by post-mortem modifications, effects of conceal- ment methods, cut injuries and neck tightening resulting in decap- itation. Drowning victims could show injuries similar to those resulting from hanging/strangulation. We found just a few cases of water immersion after strangulation and no cases of a ligature mark presenting like a loss of substance. We tried to explain the unusual appearance of the ligature mark in our case: the skin at the ligature mark lost the superficial layer and underwent dehydration, so soaking and maceration have been accelerated and produced the appearance of loss of substance. Finally, the study led to the distinction from other sources of traumatic action and the defini- tion of the cause of death.