Bruising in the anterior and lateral areas of the arms, face and neck was more often associated with physical abuse.3 On the other hand, some places have been set up where it is rare to find this type of skin manifestations in connection with daily activities, and therefore must make the clinician suspect some type of aggression, these places include: hands (in children under 4 years), back, buttock area, forearm, feet, abdomen, ears, and genital area.21,24 In addition, the presence of petechiae, linear bruises or with a certain depth of pattern of the lesion (the deeper the rupture of the vessels and the accumulation of Hb, the more the bruise will look bluish) [13] Bruises are the most common violations in most cases of physical aggression, regardless of the age group. Much is currently known about its pathophysiology, although some things have not yet been clarified (in particular, the role of biliverdin in staining lesions). Recently, new techniques for estimating the time to develop bruises have been studied in order to give this measurement greater reliability and objectivity35. Most are based on the determination of skin bruises, blunt trauma, bruise in children, bruise in the elderly, spectrophotometry, visual dating system of bruise 28 Segura, L. (2015). Basic services as a means of preventing domestic violence. Medico-legal aspects. Online. Available: www.poderjudicial.es/cgpj/es/Poder_Judicial. Accessed November 28, 2015.
In forensic science, bruising is defined as the extravasation of intracutaneous blood into the underlying subcutaneous tissue, or both.8 Such a flow of blood occurs after the rupture of blood vessels (in most bony protrusions, as well as in the anterior regions of the body). Typical sites documented in several studies where bruising that is not related to aggression is more common are the knees, chins, foreheads, and head.21, 23 of the wavelength of colors present in the bruise using colorimetric techniques such as spectrophotometry. Randeberg et al. (2006) attempted to estimate the exact decay time in living subjects using reflection spectroscopy, a technique in which the wavelength present in the colors of the lesion is determined by a spectrophotometer. The authors concluded that accuracy of up to one day could be achieved for recent hematomas, but the variability between the evolutionary times of the bruises studied did not allow statistical analysis. In addition, the method used requires the management or determination of skin parameters, such as their thickness in certain areas40. After trauma, it takes between 15 and 20 minutes for bruises to appear, and the colors they present are given by their composition: in children suffering from episodes of physical aggression, up to 82% of them may have a bruise, this type of injury being the most common in this age group2; In the elderly, bruising is considered a sign of abuse, and it has been reported that most victims, both domestic and sexual, have sustained only minor injuries such as bruising and abrasions.29 These injuries go beyond their legal relevance, as bruising in children is a worrying sign of other more serious abuses such as craniocephalic trauma, and even in infants who still move little, are indicators of possible fatal injuries in the near future7. The appearance of bruise depends on several factors: bruising, it was noted that the yellow color has a period of appearance between 18-24h; while colors such as blue, red, and purple could remain present even in a 21-day period. On the other hand, the color green is difficult to interpret, as it could be the result of the combination of blue and yellow colors10; As described above, the appearance of bruising in the initial stages depends on the concentration of extravaded erythrocytes to the affected tissues and the depth at which they are located in the skin13; Thus, among the characteristics of the bruise in groups, large or multiple with different evolution times, are more often observed in patients victims of aggression24, 25, 26. The presence of bruising in the abdominal area occurs In order to assess the bruise, it is necessary to approach the patient in the appropriate social and clinical context, taking into account the child`s stage of development, his age and, of course, the history provided by his companion23. More superficial hemoglobin tends to have reddish tones, while extravasation is observed at deeper levels in bluish tones.36, 37 In the later stages, the color of the bruise depends on although the bruise is the most common manifestation of aggression in this age group, many lesions of this type are related to the normal activity of the child20 general practitioners and dermatologists, And it is a physician who knows how to recognize, treat and interpret the bruise, because early intervention and its interpretation in court could make a difference in determining whether or not there is an assault.6 .