On gross examination, it is usually impossible to distinguish acute antemor-tem from postmortem burns. Microscopic examination of the burns is not helpful unless the victim has survived long enough to develop an inflammatory response. Lack of such a response, however, does not necessarily indicate that the burn was postmortem. One of the authors (VJMD) had occasion to examine microscopic slides of third-degree burns incurred in Vietnam, with the patients subsequently evacuated to Japan where they died 2 or 3 days later. In some of these burns, there was no inflammatory reaction, presumably caused by heat thrombosis of dermal vessels such that inflammatory cells could not reach the area of burn and produce a reaction.
If a body is severely burned, the skin might split or be completely burned away, exposing muscle (Figure 13.3). This muscle often shows rupture caused by heat. Any unburned skin will usually have a seared leathery consistency. If the victim was lying on a flat surface, while the body as a whole might be severely charred, the skin resting on the surface may be perfectly preserved. In severely burned bodies, portions of the chest and abdominal walls might be burned away, exposing the viscera. The internal organs may appear seared or charred.
Burned bone has a gray-white color, often showing a fine superficial network of heat fractures on its cortical surface (Figure 13.4). It may crumble on handling. It is quite common for the soft tissue of the face to be burned away, revealing the skull (Figure 13.5). The outer table of the exposed cranial vault may show a network of fine crisscrossing heat fractures. In some cases, the outer table can fragment and be absent. Bodies will often be brought in without hands and feet, which have been burned so badly that they are either unrecognizable at the scene or have fragmented.
Burned bodies may present with a pugilistic attitude. Coagulation of the muscle caused by heat causes contraction of muscle fibers with resultant flexion of the limbs. Thus, the upper extremities assume the position of a boxer holding his hands up in front of him. Assumption of the pugilistic
attitude is unrelated to whether the individual was alive or dead prior to the fire.
A common artifact in severely burned bodies with charring of the head is the presence of a postmortem epidural hematoma (Figure 13.6). There should be no difficulty in distinguishing these from antemortem epidural hematomas. Postmortem fire epidurals are a chocolate brown color and have a crumbly or honeycomb appearance. They are large, fairly thick (up to 1.5 cm), and typically overlie the frontal, parietal, and temporal areas, in some cases with extension to the occipital area.
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