Defence wounds and hesitation marks
- Finding
Defence wounds appear on the hands and forearms when warding off an attack; hesitation marks are earlier shallow cuts in self-injury.
What it is
Defence wounds happen when the victim tries to protect themselves: by raising the arms (passive injuries on the backs of the hands and forearms) or by grabbing the weapon (active injuries on the palm and fingers). They may be cuts, lacerations, bruises or fractures, depending on the weapon. Hesitation marks, by contrast, are superficial, parallel, grouped cuts at accessible sites (wrists, neck) that precede the main wound in self-injury. Both are small, easy to miss and very valuable for reconstructing events.
How to tell it apart
- Their absence does not exclude assault (victim surprised, unconscious or held).
- Hesitation marks also occur in self-injury without suicidal intent.
- An isolated ulnar fracture from a direct blow can be a defence injury.
- Hand wounds in the attacker (from the hand slipping onto the blade) are not defence wounds.
How to recognise it
- Defence: cuts, bruises or fractures on the forearms, hands and fingers; sometimes on the legs.
- Active: cuts on the palm and finger creases.
- Passive: injuries on the backs of the hands and the ulnar border of the forearm.
- Hesitation: several fine, parallel, superficial cuts on the wrist, neck or elbow crease.
How it forms
- Defence: the reflex of putting the arms in the way or grabbing the weapon.
- Hesitation: tentative attempts before the main wound.
- The type of defence injury follows the weapon: cuts from a knife, bruises or fractures from a blunt object.
Step by step
- Always examine both hands, forearms and fingers, on both surfaces.
- Describe each injury: type, surface (palmar or dorsal), size and orientation.
- Look for superficial parallel cuts near the main wound.
- Photograph with a scale before treatment.
- Record the person's dominant hand.
Next step: what to do and document
- Document hand injuries even when the main complaint is another wound.
- With hesitation marks, assess suicide risk before discharge and arrange mental-health care.
- With defence wounds, consider assault: follow the reporting pathway and keep the clothing with chain of custody.
- Describe without labelling the manner: write "injuries on the palmar surface of the fingers" rather than "defence wounds" if you are not certain.
Common mistakes
- Not examining the hands of a patient with wounds to the trunk.
- Concluding there was no assault because defence wounds are absent.
- Discharging a person with hesitation marks without assessing suicide risk.
Test yourself
Think of the answer, then tap the question to see it.
Where are active defence wounds found?
On the palm and the palmar surface of the fingers, especially between thumb and index finger, from trying to grab the blade.
What are hesitation marks and what do they suggest?
Superficial, parallel, grouped cuts next to the main wound at accessible sites; they point to self-injury.
Does the absence of defence wounds rule out an assault?
No. The victim may have been surprised, unconscious or held.
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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: Pattern and Forensic Significance of Defense Injuries in Homicide Cases: A Cross-Sectional Study (Cureus (PMC), 2025); Fatal and nonfatal sharp force injuries to the limbs: a study of forensic autopsies in Sweden (2010–2019) (International Journal of Legal Medicine (PMC), 2025); Fatal Self-Inflicted Chop Wound by a Supari Cutter (Sudi): A Rare Case With Forensic Analysis of Wound Patterns and Weapon Biomechanics (Cureus (PMC), 2026).
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