Incised-wound location, direction and associated circumstances help distinguish suicidal, homicidal and accidental injuries.
Suicidal incised wounds
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Usual sites include the flexor wrists, outer left arm and forearm, front and outer thighs, and front of the abdomen and chest. Fatal incised wounds of the arms are almost always suicidal.
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Suicidal chest wounds are usually left-sided and directed downwards and inwards. A wound caused by running onto a knife tends to be more horizontal.
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The person usually exposes the intended site, such as by opening the collar or raising the shirt.
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Wrist hyperextension before cutting can cause the radial artery to slip at the lower end of the radius and escape injury. Flexor tendons may be cut.
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Suicides usually do not injure the face.
Self-injury in mental disorder
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Some mentally disordered persons inflict hundreds of small wounds. Numerous arm cuts may cross each other, and small stab wounds may occur on the chest or temples.
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Paranoid schizophrenics with strongly religious delusions may remove the penis, scrotum and testes. Ears and nose may also be mutilated.
Homicidal wounds and fatal cut-throat injury
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Homicidal wounds are usually multiple and may occur anywhere. Chest wounds cover a wider area and are more horizontal; an upward direction is rarely seen in suicidal wounds.
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Incised wounds on the back or at sites difficult for the person to reach are described as homicidal.
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Incised wounds of the nose, ears and genitals are usually homicidal and may be inflicted for jealousy or revenge in adultery, causing disfiguration.
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Cut-throat wounds may cause immediate death through haemorrhage, air embolism or inhalation of blood into the respiratory tract.
Accidental incised wounds
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Accidental incised wounds are usually minor and occur in the home or workshop.
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They may result from falling onto a sharp weapon or object, or from broken glass. They can occur anywhere but are common about the hands.