Ligature strangulation

What it is

Ligature strangulation is compression of the neck by a ligature (cord, cable, belt, garment) tightened by a force other than the body's weight, almost always another person. Most are homicides; suicide is possible if the ligature stays tight with several knots or a tourniquet. The typical furrow is horizontal, continuous around the neck, low and of even depth, and the face is usually markedly congested with many petechiae above the ligature.

How to tell it apart

• Versus hanging: oblique, high furrow broken at the knot (see the table on the hanging page).
• Versus manual strangulation: no furrow, but round fingertip bruises and nail abrasions.
• Hanging with a multi-turn noose or a drop onto the noose: may give horizontal segments that confuse.
• Artefacts: a tight collar, neck folds or decomposition can mimic a furrow.

How to recognise it

• A horizontal furrow running continuously round the neck, sometimes with crossed ends or a knot impression.
• Middle or low level on the neck, at or below the thyroid cartilage.
• Even depth; it may be faint with wide soft ligatures and sharp with thin hard ones.
• Congested, cyanotic face, with petechiae in the conjunctivae, eyelids and skin above the ligature.
• Crescent-shaped fingernail abrasions and bruises around the furrow; haemorrhages in the neck muscles.

How it forms

• A tightened ligature first occludes the jugular veins while arterial blood still flows in: the head congests and petechiae appear.
• Sustained pressure occludes the carotids and causes loss of consciousness; it may compress the larynx.
• The victim's struggle leaves abrasions from their own nails and defence injuries.

Next step: what to do and document

• In a living victim: assess airway, voice, swallowing and neurological state, and document injuries even if minimal.
• Photograph the furrow with a scale and describe direction, level, width, continuity, pattern and crossed ends.
• Cut the ligature away from the knot, keep the knot intact and package it with a chain of custody.
• Collect nail scrapings or clippings from the victim and protect their hands with paper bags.
• Notify the judicial police; in a partner context, follow the violence care pathway and report to the surveillance system.

Common mistakes

• Ruling out strangulation because the furrow is faint: wide soft ligatures leave little mark.
• Attributing fingernail abrasions to the assailant without considering that they are often the victim's.
• Removing the ligature by untying the knot instead of cutting away from it.
• Not scraping or clipping the victim's nails to look for the assailant's material.

Test yourself

Think of the answer, then tap the question to see it.

Add to my cards (4)

Elsewhere in DurgiPedia

• Mandatory reporting: public health, violence and abuse

Connections

← All of forensic medicine

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: Ligature Mark: Crime or Suicide? (International Journal of Environmental Research and Public Health, PubMed Central, 2022); Strangulation Injuries (StatPearls, NCBI Bookshelf, 2023); Approach considerations for the management of strangulation in the emergency department (JACEP Open, PubMed Central, 2022).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Send

Representative model, for educational purposes only.