State-of-the-Art on Wound Vitality Evaluation: A Systematic Review

Abstract

The vitality demonstration refers to determining if an injury has been caused ante- or post-mortem, while wound age means to evaluate how long a subject has survived after the infliction of an injury. Histology alone is not enough to prove the vitality of a lesion. Recently, immunohistochemistry, biochemistry, and molecular biology have been introduced in the field of lesions vitality and age demonstration. The study was conducted according to the preferred reporting items for systematic review (PRISMA) protocol. The search terms were "wound", "lesion", "vitality", "evaluation", "immunohistochemistry", "proteins", "electrolytes", "mRNAs", and "miRNAs" in the title, abstract, and keywords. This evaluation left 137 scientific papers. This review aimed to collect all the knowledge on vital wound demonstration and provide a temporal distribution of the methods currently available, in order to determine the age of lesions, thus helping forensic pathologists in finding a way through the tangled jungle of wound vitality evaluation.

Keywords: autopsy; histology; immunohistochemistry; protein quantification; ribonucleic acids; vitality; wound.

Figure 1

Our review strategy following PRISMA standards.

Figure 2

The timing of positivity of several immunohistochemical vitality markers after wounding. This figure includes exclusively markers for the skin. GM-CSF, granulocyte macrophage-colony stimulating factor; ICAM-1, intercellular adhesion molecule 1; IL, interleukin; iNOS, inducible nitric oxide synthase; MCP, monocyte chemoattractant protein; MMP, matrix metallopeptidase; RAGE, receptor for advanced glycation endproducts; TNF-α, tumor necrosis factor α; VEGF, vascular endothelial growth factor; VCAM-1, vascular cell adhesion molecule-1.

Figure 3

The differential expression of different biomarkers and electrolytes variations in skin as time (days) after wounding progress. H means “hours”; d means “day(s)”. We included all the biomarkers that showed a variation (increasing or decreasing) before 21 days. Regarding the biomarkers that showed an expression during an interval, only the upper limit has been considered. *IL 6 has been considered in different studies; it shows a different expression only in two studies.

Figure 4

This figure shows the differential expression of miRNA in time (days) after wounding. We included only those miRNAs that showed a variation in expression, according to a precise timeframe. miRNAs variations that occurred within the first 24 h are summarized on the first day. *miR-183–3p shows different expressions in rats and humans; in rats, it was overexpressed within 120 h after wounding, whereas in humans, it was in 48 h. ↑ indicates up-regulation; ↓ down-regulation.