Page 141 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

ISTANBUL PROTOCOL V. PHYSICAL EVIDENCE OF TORTURE AND ILL-TREATMENT

to the original trauma and that some lesions may viscosity of the liquid – for example, a highly viscous
have faded by the time of re-examination. 429 burn from molten plastic will be deep and relatively
circumscribed, compared with a burn from hot water,
429. Lacerations, a tearing or crushing of the skin and which may show initial impact, spread according to
underlying soft tissues by the pressure of blunt gravity and sometimes satellite burns from splashes.
force, develop easily on prominent bony landmarks Cigarette burns often leave 5–10-millimetre diameter
of the body, since the skin is compressed between circular or ovoid macular scars with a hypo or
the blunt object and the bone surface under the hyperpigmented centre and a hyperpigmented,
subdermal tissues. However, with sufficient force the relatively indistinct, periphery. The diameter of such
skin can be torn on any part of the body. Whether scars may vary with the type of cigarette. Brush burns
a laceration rather than a bruise is sustained from from cigarettes may leave less distinctive lesions. The
blunt force trauma depends not only on the part of burning away of tattoos with cigarettes has also been
the body affected but also on other factors, including reported in relation to torture. The characteristic shape
the force applied, the contour of the implement and of the resulting scar and any tattoo remnants will help
the presence or absence of protective clothing. in the diagnosis. Burning with hot objects may produce
lesions that reflect the shape of the instrument and are
430. Scars resulting from whipping may be seen if full initially sharply demarcated with narrow hypertrophic
thickness wounds have been caused. These scars may or hyperpigmented marginal zones corresponding to
be hypo or hyperpigmented and may be hypertrophic, an initial zone of inflammation. Burn edges, which
often depending on skin tone and location. Whipping are initially sharply demarcated, over time become
may not cause scars, it may only cause wheals and blurred, from migration of melanocytes, particularly
bruising depending on the nature of the implement, the noted in those with more pigmented skin. This may,
force used, the number of lashes and any protection for instance, be seen after burning with a heated
afforded by clothing. Self-flagellation as part of metal rod or a gas lighter. Spontaneously occurring
religious ritual may produce scars similar to those from inflammatory processes lack the characteristic marginal
punitive whipping. Symmetrical, atrophic, depigmented zone and only rarely show a pronounced loss of tissue.
linear changes of the abdomen, lower back, axillae Following a burn produced by burning rubber or
and legs, which are sometimes claimed to be torture molten plastic, hypertrophic or keloid scars may form.
sequelae, may be striae distensae and represent
previous growth, pregnancy or increase in weight, and 432. When the nail matrix is burnt, subsequent growth
must be distinguished from those related to torture. 430 produces striped, thin, deformed nails, sometimes
An individual who describes being beaten or whipped broken up in longitudinal segments. If a nail has
on the back may have been previously unaware of been pulled off, an overgrowth of tissue may be
striae there until they are identified in the examination produced from the proximal nail fold, resulting in the
and so innocently assume that they are a result of the formation of pterygium. However, it is possible for a
torture. Striae distensae may be found around the normal nail to regrow. Changes in the nail caused by
axilla after reported suspension and attributed by the Lichen planus constitute the only relevant differential
person to the torture. Use of skin lightening creams diagnosis, but they will usually be accompanied by
may exacerbate the appearance and size of striae. widespread skin injury. On the other hand, fungus
infections are characterized by thickened, yellowish,
431. Burns may leave permanent changes in the skin, in crumbling nails, different from the above changes.
the form of pigmented lesions or scars, depending on Fungal infection may coexist in the damaged nail.
the depth of the burn and the skin type. Pigmented
lesions following a partial thickness burn may persist 433. Sharp trauma wounds are produced when the skin is
for months or years before gradual resolution. The cut with a sharp object, such as a knife, bayonet or
temperature of the heated object or substance and, broken glass, and include stab wounds, cut or slash
secondarily, contact time are the chief determinants of wounds and puncture wounds. The acute appearance
the appearance and depth of a burn. Burns from hot is usually easy to distinguish from the irregular and
liquid will vary in depth and shape depending on the torn appearance of lacerations and scars found upon

429 Jason Payne-James, Jack Crane and Judith A. Hinchliffe, “Injury assessment, documentation, and interpretation”, in Clinical Forensic Medicine: A Physician’s Guide, 2nd ed.,
Margaret M. Stark, ed. (Totowa, New Jersey, Humana Press), pp. 127–158.
430 Karlijn Clarysse and others, “Skin lesions, differential diagnosis and practical approach to potential survivors of torture”, Journal of the European Academy of Dermatology
and Venereology, vol. 33, No. 7 (2019), pp. 1232–1240.

102