Les marqueurs de vitalité des blessures en pathologie médicolégale

Skin wounds datation is one of the most challenging problems in forensic pathology. The vitality of a recent wound cannot be affirmed when no inflammatory cell is visible. There are in the literature numerous studies about wound vitality, looking for markers involved in coagulation or inflammation, using various methods such as enzymology, molecular biology or immunohistochemistry. In this update, we first introduce some methodological principles to respect. Then, we review the main studies available in the literature. We insist on immunohistochemistry, which seems to be the more valuable method, given its easiness to perform and the possibility to analyze the localization of the molecules of interest. Some markers are promising, such as TNFα, IL-6, IL-1β, TGFα or TGFβ1. Before using them in daily practice, these first results need to be confirmed with other studies, driven by independent teams and integrating multiple controls. Most notably, the antibodies have to be tested in numerous post-mortem wounds. Indeed, there is a critical risk of overexpression in post-mortem wounds, and some interesting markers have been secondary invalidated because of post-mortem false positivity (e.g. fibronectin, P-selectin). Finally, optimal sensibility and specificity values would be probably reached by combining several markers, validated with large groups of pre- and post-mortem wounds.