Forensic Autopsy: Types, Incisions & Techniques

An autopsy is a surgical technique that entails a detailed examination of a body by dissection to determine the cause, mode, and manner of death. It is also referred to as a post-mortem examination, obduction, necropsy, or autopsia cadaverum. 

The examination may also be conducted for scientific or educational purposes to evaluate any illness or injury that may be present. Only animal bodies are normally discussed when the word "necropsy" is used.

A pathologist, a specialty doctor, frequently performs autopsies. Only a very small fraction of fatalities, in some cases, require an autopsy. A medical examiner or coroner may typically identify the cause of death.

Autopsies come in two basic categories: forensic and clinical. When a death is suspicious, violent, or from an unidentified cause, the first procedure is carried out. at order to identify and better comprehend the reasons of death, the second is carried out at the hospital by the pathologist with the next of kin's permission.

Types Of Autopsy

Medicolegal Autopsy

• M/C type of autopsy in India
• Done in unnatural deaths - Suicide, Homicide
• Consent from Investigation officer (IO), Police/ Magistrate
• Complete autopsy
• Body to be handed over to IO

Clinical / Pathological Autopsy

• Done in Natural deaths
• Relative give consent (cannot be done without consent)  
• Body to be handover to Relatives
• Partial autopsy
• Negative autopsy: 
  • Doctor will not be able to state the cause of death. 
  • It may be due to incorrect technique, lack of experience, incorrect preservation etc.
• Psychological Autopsy (No Dissection)
  • Done in suicidal deaths
  • Done to know about the psychological state of person before committing suicide.
  • Conduct interviews with parents/ friends.

Different Types of skin Incisions

Following are the different types of skin incisions used for performing autopsy - 

1. “I” Incision

• Starting from chin to pubic symphysis
• Most commonly used.

2. “Y” Incision

• Starting from shoulders on both sites reach Xiphisternum and it comes down to the pubic symphysis.

3. Modified “Y” Incision

• Starts from mastoid comes down the lateral site of neck and then from suprasternal notch to Pubic Symphysis
• Good for neck dissection
• Preferred in Asphyxial deaths.

4. Inverted “Y” incision

• Starts from the chin in midline and comes down at the umbilicus it bifurcates and moves to the respective iliac crest.

5. “T” incision

• Transverse incision starts from one acromion process to other and the vertical incision from suprasternal notch to pubic symphysis.

6. “X” incision

• Put on back of body
• Skin is reflected and look for deep contusion
• Seen in custodial deaths

Different Techniques of Organ Removal in Autopsy

There are a number of general and specific autopsy techniques. Let’s learn important details on these different techniques below -

• Virchow’s Method
  • One by one removal of organs
  • M/C method used.
• Letulle’s / En mass Method
  • En-Mass Removal or Evisceration
  • RAPID method
  • Also used to study anatomical relation
  • Removal of attachment of tongue and from there we remove all the thoracoabdominal organs together as a single mass. Then we dissect the organs.  
• Ghon’s Method
  • En–bloc Removal
  • Targets only one particular area.
  • Ex: In Sexual offence - Only pelvic organs are removed. In Thoracic pathology/ Trauma - Only thoracic organs are removed.
• Rokitansky Method
  • In-situ method
  • Organ not removed outside the body to avoid spillage and exposure. 
  • Used for infectious diseases.
  • Example: HIV, Hepatitis patient,Covid pt.

Heart Dissection

• Inflow outflow method: Start cutting from RA → RV → LA → LV

Brain dissection

• Can be done as Fresh ( commonly done) or Fixation with Formalin (best)

Stomach dissection

• Double ligation method 
  • Cut the stomach out by applying two ligatures at the ends and cut in the middle.
  • The area along lesser curvature has max damage due to poisoning. This is known as Magenstrasse
  • So, we open our stomachs along greater curvature in poisoning cases.

Spinal cord dissection

• Not routinely opened unless we suspect spinal injuries
• 2 approaches: anterior and posterior.
• Posterior is easier and better.

Air embolism 

• Pyrogallol test , done to detect air embolism , Brown color indicates positive test 

Which cavity to be opened first when starting an autopsy?

• Cranium 
  • In poisoning cases
  • Asphyxial cases to decompress vessels
• Thorax
  • Pneumothorax case to demonstrate presence of air in thorax
• Abdomen 
  • New born babies: to check level of diaphragm
• Asphyxia deaths: Cranium → Thorax → Abdomen → Neck
  • This is to provide bloodless dissection.

Skull

• In fetus: Beneke’s method and Barr’s method.

Related Previous Year Question

Q. In autopsy, the doctor tied the bronchus and checked the floating and sinking of the lung. The test is identified as? 

A. Getter’s test

B. Diatoms test

C. Hydrostatic test

D. Ploquet’s test

Answer: Hydrostatic test

Q. In the corrosive acid case, the stomach is opened along? 
A. Lesser curvature 

B. Greater curvature 

C. Vertical 

D. Pylorus

Answer: Greater curvature

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