Resolution of subcutaneous haemtomas, comparison of upper versus lower extremity in healthy adults

In forensic medicine haematomas are important findings in physical abuse.
Physical abuse occurs at any age, although in mainstream media most of the
attention is focussed on child abuse and to a lesser extend to elder abuse.
Child abuse is an important social and medical problem with an increasing
number of reported cases annually. In the Netherlands studies have shown that
annually approximately 118.000 children (3% of all children) aged 0-18 are the
victim of physical abuse. With respect to elder abuse the figures are less
clear but the estimate is that annually 200.000 elderly are victim of abuse,
this includes all forms abuse not just physical.

It is known that physical examination and visual inspection of haematomas is
unreliable and therefore there is a need for a reliable and validated method.
This to be able to create a timeline which can be used to identify or exclude
potential suspecdts. A potential tool that can be used by first line forensics
is the use of spectroscopy. With the aid of a spectral camera it is possible to
assess the amount of absorption of a bruise and thus geographically map the
chemical information. This makes it possible to detect chemicals in the skin
(e.g. haemoglobin and bilirubin) and to assess the size of the area where these
chemical are deposited. For age assessment, or the change over time, of a
haematoma this assessment of haemoglobin and bilirubin is essential. Using a 3D
model of healing haematomas, developed in the Amsterdam Medical Center, it is
possible to assess the age of the haematoma under investigation.
In order to assess the accuracy and robustness of this method it is mandatory
to validate in. In the past several successful in-vitro studies on blood stains
and in-vivo studies in adults have been done. However, to date there are no
studies in the influence of the location on the healing process of haematomas.
For forensic purposes this is an important question, because if there is an
influence of location on the healing process, this approach might be less
reliable and not directly applicable in court of law.

Using a previously published standardised methods haematomas will be inflicted
in adult healthy volunteers. This method consists of a 1 meter tube positioned
vertically through which a 400 gram weight will be dropped on the extremity.
The location of the induced bruise will be marked using a waterproof marker.
The locations that will be assessed in this study are the volar side of the
dominant lower arm and the calf on the ipsilateral side.
Prior to the experiment a spectral photo will be obtained, followed by a
spectral photo directly after impact. Spectral photography will be repeated in
24 hour intervals on the next 6 days.

We don*t expect complications or side-effects in this study. A previous study
in healthy adult volunteers showed an average pain score of 4.1 on a scale of 1
* 10.