A complex suicide by vehicle assisted ligature strangulation and wrist-cutting

Background: Complex suicide defines the type of suicide involving using more than one suicide methods to lead to death. Second method is used to escape from pain or to prevent failure of the first method. Here we present a case of unusual complex suicide case by vehicle assisted ligature strangulation and wrist-cutting. Case: A 38 year-old male was found dead in his automobile at roadside out of his hometown. At crime scene investigation, driver side window was open and a ligature surrounding the victim's neck was attached to a tree 8 m behind the car. The victim's shirt and trousers were blood soaked due to bleeding from wrist cuts. There was a suicide note on the front panel of the car. At external examination there was a ligature mark, 1 cm in width, gently sloping upward toward the notch at left side of occipital region. Additionally, multiple wrist-cuts of approximately 5 cm in length were noticed on anterior side of both wrists. There was no injury of thyroid cartilage or hyoid bone, in internal examination. There was a soft tissue hemorrhage with 0.5 cm diameter around left greater horn of the thyroid cartilage. There was no injury of ulnar or radial vessels. No traces of alcohol or drugs were detected in toxicological analyses. Death was attributed to vehicle assisted ligature strangulation. Conclusion: A complete forensic investigation revealed the case was an unusual complex suicide by vehicle assisted ligature strangulation and wrist-cutting. The case was interesting in terms of involving car assisted ligature strangulation.