[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Asphyxia and physical agents](https://durgical.com/en/forensic-medicine/areas/asphyxia-physical/) › Ligature strangulation # Ligature strangulation - Finding In ligature strangulation a force other than body weight tightens the neck; it leaves a horizontal, continuous, low furrow. Updated Nov 5, 2026 ## Key points - Horizontal, continuous, low furrow (at or below the thyroid cartilage) of even depth. - Marked congestion and petechiae of the face and conjunctivae: compression occludes the veins before the arteries. - Fingernail abrasions near the furrow: often the victim's own, trying to pull the ligature off. - Most are homicides; in suicidal strangulation the ligature is held tight by knots or a tourniquet. - Petechiae are non-specific: they support compression but do not prove it on their own. ## 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. ## What does a ligature strangulation furrow look like? Horizontal, continuous around the neck, low (at or below the thyroid cartilage) and of even depth. ## Why is the face usually congested with petechiae in ligature strangulation? Because the ligature occludes the jugular veins while the arteries keep carrying blood to the head. ## Whose are the fingernail abrasions near the furrow, usually? Often the victim's own, made while trying to pull the ligature off the neck. ## Is suicidal ligature strangulation possible? Yes, though rare: the ligature must stay tight without the person's force, with several knots or a tourniquet. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/ligature-strangulation/) ## Elsewhere in DurgiPedia - [Mandatory reporting: public health, violence and abuse](https://durgical.com/en/medical-ethics/mandatory-reporting-public-health-violence-and-abuse/) ## Connections ## Related 6 - [Hanging](https://durgical.com/en/forensic-medicine/hanging/) - [Manual strangulation (throttling)](https://durgical.com/en/forensic-medicine/manual-strangulation/) - [Mechanical asphyxia: types and the general signs](https://durgical.com/en/forensic-medicine/mechanical-asphyxia-types-and-the-general-signs/) - [Defence wounds and hesitation marks](https://durgical.com/en/forensic-medicine/defence-wounds-and-hesitation-marks/) - [Chain of custody (cadena de custodia) in the hospital or rural post](https://durgical.com/en/forensic-medicine/chain-of-custody-in-the-hospital-or-rural-post/) - [Intimate-partner and gender-based violence](https://durgical.com/en/forensic-medicine/intimate-partner-and-gender-based-violence/) ## Related conditions 1 - [Intimate partner and sexual violence (mental-health care)](https://durgical.com/en/conditions/intimate-partner-and-sexual-violence/) [← All of forensic medicine](https://durgical.com/en/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?](https://pmc.ncbi.nlm.nih.gov/articles/PMC9655629/) (International Journal of Environmental Research and Public Health, PubMed Central, 2022); [Strangulation Injuries](https://www.ncbi.nlm.nih.gov/books/NBK459192/) (StatPearls, NCBI Bookshelf, 2023); [Approach considerations for the management of strangulation in the emergency department](https://pmc.ncbi.nlm.nih.gov/articles/PMC9013263/) (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 Representative model, for educational purposes only. --- Source: https://durgical.com/en/forensic-medicine/ligature-strangulation/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/ligature-strangulation/