ORIGINAL ARTICLE

Which Knife Was Used?

Using a Porcine Model to Assess Stab Wound Size
Allison Zohn* and Judy Melinek, MD*†‡

develop a porcine model that would allow pathologists to define

Abstract: Forensic pathologists who autopsy stab wound victims may reasonable limits to guide expert testimony within statistically
be called upon to determine whether a specific weapon recovered as ev- significant parameters.
idence caused the decedent's wounds. Some forensic training programs
instruct pathologists to excise wounds and place them in formalin.
There is little published information about the reliability of these as-
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sessments. To address these deficiencies, a porcine model was used to METHODS AND MATERIALS
establish the limits of in situ knife wound measurements of wounds
caused by 3 knives of different widths stabbed at 90 degrees to the skin
Three knives, labeled A, B, and C (Fig. 1), were each mea-
surface. The results indicate that within the 95% confidence interval,
sured at a distance of 3 in from the tip of the blade. Knife A
most stab wounds when measured on the surface of the skin will be
measured 19 mm, knife B measured 27 mm, and knife C mea-
within 1 to 3 mm of the size of the knife blade. Four wounds from dif-
sured 29 mm (Fig. 2). The knives were marked and wrapped
ferent anatomical areas of the pig were excised from the body, and af-
with duct tape to prevent overpenetration. An on-line random
ter excision, their measurements differed from their in situ length.
number generator was used to randomly assign a knife to each
After fixation in a 10% buffered formalin solution, one wound stayed
sequential stab wound.2 An 80-lb pig (which measured 46 in
the same, one wound lengthened, one shrunk minimally, and the one
from snout to rump and had a torso height of 11 1/2 in) was
from the thinner abdominal skin shrunk by 6 mm (11%). This study
stabbed 176 times by the 3 knives, with the knives held at 90
presents a porcine model that can be used to define parameters
degrees from the skin surface, to avoid any increase in length
for testimony.
caused by a diagonal cutting angle (Fig. 3). The average distance
between individual stab wounds was 1 in. No stab wounds
Key Words: stab, wound, size, porcine, pig, model, excision overlapped or altered the measurement of another stab wound.
(Am J Forensic Med Pathol 2017;38: 180–183) The average surface area of the pig is 10429 cm2. The esti-
mated total surface area stab wounds covered range from
6430 to 7192 cm2.3 Stab wounds that were blocked by bone
I n criminal cases, pathologists may be asked to interpret injuries
on the decedent and see whether a particular weapon could have
caused the wounds. Sometimes, this occurs in the setting of an on-
or cartilage and did not reach the depth of 3 in were crossed
out and discounted. The remaining stab wounds were marked
going police investigation, when there are multiple weapons at the with sequentially numbered labels, and a forensic pathologist
scene or when a weapon has been recovered elsewhere and the pa- who was blinded to the knife designations measured the
thologist has direct access to the body at autopsy. Other times, pa- wounds with a standard forensic ruler (Medtech Forensics) and
thologists are asked to testify in court to “rule in” or “rule out” a recorded the wound sizes. The edges of gaping wounds were
weapon given evidence presented at trial upon review of the au- reapproximated by either squeezing the sides or lengthening
topsy report and photographs, without direct access to the body. the edges (which resulted in identical measurements). One
Although a few textbooks in forensic pathology address how to crossed-out wound that was accidentally measured and mistak-
make such comparisons, there are no current peer-reviewed stud- enly assigned to an adjacent numbered wound by the pathologist
ies addressing the reliability of using wound measurements in was excluded. After unblinding, a total of 119 stab wounds were
sharp force injury to match a particular weapon. In previously
published studies using pigs as models for humans, identifica-
tion of tool mark striations proved difficult when comparing
blades to the injury.1 Although texts emphasize reapproximating
wound edges by squeezing the edges of stab wounds together,
they give little guidance about the lower limits that define when
a wound is too small to have been caused by a large knife. Al-
though some wounds may be smaller because of the inherent
elasticity and plasticity of skin and soft tissue, we wanted to

Manuscript received October 24, 2016; accepted April 2, 2017.

From the *University of California, Davis; †Alameda County Sheriff-Coroner,
Oakland; and ‡PathologyExpert Inc, San Francisco, CA.
The authors report no conflict of interest.
Reprints: Judy Melinek, MD, 3739 Balboa St, #102, San Francisco, CA 94121.
E-mail: drjudymelinek@pathologyexpert.com.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0195-7910/17/3803–0180
DOI: 10.1097/PAF.0000000000000318 FIGURE 1. Knives A, B, and C.

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Am J Forensic Med Pathol • Volume 38, Number 3, September 2017
FIGURE 2. Knife A = 19 mm. Knife B = 27 mm. Knife C = 29 mm.
of the correct depth to be included in the study. Four wounds
representing a full range of sizes, from different anatomical areas
of the pig, were excised from the body, measured after removal,
photographed (Fig. 5), and placed in 10% buffered formalin. Af-
ter 10 days of fixation, the excised wounds were measured with
the same ruler.
For statistical analysis, a confidence interval test was used at
the 0.05 level using Microsoft Excel statistical tools and con-
firmed by manual calculation. The confidence interval test was
used because it provides an estimate of the parameters for the
mean values of the stab wound lengths.
RESULTS
Stab wounds can be up to 6 mm smaller than the width of
the blade at the estimated depth of penetration, but this is un-
likely (a single outlier for knife B) (Table 1). A smaller wound
can occur if the knife was not inserted to the measured depth.
To stay within 95% confidence interval, most stab wounds
when measured in skin will be within 1 to 3 mm of the size
of the knife blade. However, if a knife is thrust in at an angle
not perpendicular to the skin, a wound may be infinitely bigger
than the width of the knife due to the angle of penetration.
The results (Table 2) support that at a 0.05 level of significance,
there is a 95% confidence that the mean length of stab
FIGURE 3. Penetration 90 degrees to skin surface.
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Which Knife Was Used?
wounds from knife A was between 19.3 and 20.3 mm. The
mean stab wound length for knife B was between 28.2 and
30.0 mm at the 95% confidence level. The mean stab wound
length for knife C was between 27.3 and 28.8 mm at the 95%
confidence level.
Four wounds representing a full range of sizes, from
different anatomical areas of the pig, were excised from
the body (Fig. 4). After excision, their measurements dif-
fered from their in situ length, with 3 wounds lengthening
and 1 wound shortening (Table 3). One wound excised from
thin abdominal skin measured 12 mm longer after excision
compared with its in situ measurement, and the skin was
noticeably more flaccid than the sections excised from the back,
shoulder, or flank (Fig. 5).
DISCUSSION
Porcine models have been used in biomedical research be-
cause their cardiovascular, urinary, digestive, and integumen-
tary systems as well as organ size are similar to humans.4–6
Studies of newborn pig membrane permeability and absorption
have demonstrated that the skin of pigs is the most suitable
model for human skin.7,8 In forensic studies, pigs have been
used to determine the age and histological parameters of
bruises, assess electrical and thermal injuries, establish decom-
position rates for estimating the post mortem interval, measure
stab wound force, and define the patterns of injury caused by
knife wounds.9–15 This study presents a porcine model that
can be used to define parameters for testimony and allows a fo-
rensic pathologist to opine with reasonable certainty that a
knife wound 3 mm smaller than the width of the knife at the
measured at the depth of penetration would most likely not
TABLE 1. Range and Lower Limit of Stab Wound Lengths
Among Three Blades
Lower Limit, mm
Blade Width Wound (Difference Between Knife
Knife at 3", mm Lengths (mm) Blade and Smallest Wound)
A 19 16–24 3
B 27 21–35 6
C 29 25–40 4
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Zohn and Melinek
TABLE 2. Stab Wound Lengths
Total No. Length, 95% Confidence
Knife Stab Wounds Mean (SD), mm Interval (α = 0.05)
A 34 19.79 (1.493) (19.27011–20.3099)
B 43 29.11 (2.96) (28.19905–30.02095)
C 42 28.05 (2.487) (27.2748–28.825197)
have been caused by that knife. This study does not describe
the parameters for stab wounds greater in length than the knife
due to varying stab wound lengths that would occur with differ-
ent angles of knife penetration. One limitation of this study was
that the knives used were sharp and single edged. Additional
studies should be performed to assess injuries from double-
edged blades, dull knives, or other penetrating instruments.
Stabbing was done by hand and not by a machine, because
the degree of force was not being measured and had to vary
on the basis of the location of the wound to get the desired
depth. Finally, only 1 pathologist measured the wounds, be-
cause most autopsies are conducted by 1 practitioner. Interob-
server variability in measurements was not assessed but
would also be recommended for future investigations.
Wound excision should not be taught as a method to pre-
serve evidence. The excision of wounds from a cadaver cuts
the subcutaneous elastin fibers that maintain skin tension.
These elastin fibers are well described in the surgical and fo-
rensic literature and cause stab wounds to gape. They cause
Langer lines: the lines that surgeons respect to prevent gaping
in surgical wounds. In forensic texts and published studies, it
is well described that stab wounds parallel to Langer lines will
not gape, whereas those perpendicular or diagonal to them
will.16 DiMaio and Dana, in their seminal text Forensic Pathol-
ogy, instruct that “if the edges of a gaping wound are drawn to-
gether, the size of the restored wound approximates the
maximum possible width of the knife blade.”17 In this porcine
model, squeezing the sides of the wounds or lengthening the
wound edges resulted in identical measurements and approxi-
mated the width of the knife blades used within measurable pa-
rameters. According to Chapman, “elasticity of the skin can
cause the measurements of the wound to vary by one to two
millimeters so that the wound length can in some cases be
FIGURE 4. Four excised stab wounds before (left) and after (right) formalin fixation.
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Am J Forensic Med Pathol • Volume 38, Number 3, September 2017
TABLE 3. Stab Wound Excision and Formalin Fixation Effect on
Wound Length
Knife Blade Width In situ Excision Formalin Anatomic
(SW#) at 3" Length Length Fixed (10 d) Location
A #34 19 16 18 18 Flank
B #9 27 27 25 27 Shoulder
C #20 29 25 27 26 Back
C #23 29 40 52 46 Belly
slightly less than the width of the knife,” but this statement
has no accompanying reference.18 This study supports that
the maximum allowable narrowing of a stab wound in situ as
compared with the knife blade is 6 mm but that most stab
wounds that penetrate at 90 degrees will be within 1 to 3 mm
of the size of the blade.
Shrinkage of cutaneous tissue occurs after excision due
to the tissue contractility, but in this model, stab wound size
was mostly increased with excision.19 Wound excision did
not reliably preserve wound measurements. Formalin fixation
alters the chemical composition of skin by cross-linking col-
lagen fibers and “hardening” the tissue, altering it further.
Published studies document shrinkage of canine cadaver skin
length and width when fixed in a 10% formalin solution.20,21
Feline skin also experienced a mean of 32.4% decrease length
and 34.21% decrease in size when tissue was fixed in a
neutral-buffered 10% formalin solution for just 36 hours.22
Formalin-fixed excised wounds should not be relied upon
for measurements, and the forensic pathologist should have
a reliable photographic record of wounds both in the original
(if gaping), and reapproximated orientations with adjacent
rulers to allow for outside review and quality control of autopsy
wound measurements.
This study supports a forensic pathologists' ability to testify
within reasonable certainty whether a knife caused a certain stab
wound based on the length of the wound at an established depth
of penetration. A stab wound that is greater than 3 mm smaller
than the width of the knife at the matched depth of penetration
is unlikely to have been caused by that weapon. Furthermore,
the length of a stab wound after excision and/or formalin fixation
should not be relied upon in legal proceedings for ascertaining
which weapon was used.
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Am J Forensic Med Pathol • Volume 38, Number 3, September 2017
FIGURE 5. Wound number 23 in situ, after excision, and after formalin fixation. Note how the shape and size of the skin and wound are altered
when photos are matched by the yellow centimeter label size.
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