ĐẶC ĐIỂM DẤU BỎNG ĐIỆN VÀ TỔN THƯƠNG CƠ TIM Ở NẠN NHÂN TỬ VONG DO ĐIỆN TRONG GIÁM ĐỊNH PHÁP Y

Abstract

Background: Fatal electrocution remains a common cause of death in Vietnam. However, forensic diagnosis is often challenging because electrical burns may be absent or nonspecific on gross examination, and myocardial lesions have not been systematically evaluated in many cases. Objectives: To describe the gross and histopathological characteristics of electrical skin burns and myocardial lesions in fatal electrocution cases, and to analyze the association between these findings. Methods: A descriptive case series was conducted on 56 fatal electrocution cases autopsied at the Ho Chi Minh City Forensic Center between 2022 and 2024. Gross and microscopic features of the skin and heart were recorded. Statistical analysis was performed using STATA software. Results: Males accounted for 87.5% of cases (male-to-female ratio 7:1). The mean age was 35.3 ± 15.8 years (range: 2–77 years), with most victims being of working age. Occupational accidents were the most common circumstances (57.1%), followed by domestic accidents (41.1%). On gross examination, electrical burns were identified in 92.9% of cases, most commonly presenting as central crater-like lesions (80.4%); 7.1% of cases showed no visible electrical burns. Histopathological examination of the skin revealed frequent findings, including basal and spinous layer nuclear alterations (98.2%), epidermal detachment (96.4%), collagen fiber coagulation (96.4%), vascular thrombosis (89.3%), intraepidermal or dermal vacuolization (75%), and adnexal structural changes with loss of the dermoepidermal junction (60.7%). Gross cardiac findings included subepicardial hemorrhage (64.3%), myocardial infarction (25%), and myocardial necrosis (16.1%). Microscopically, common myocardial alterations were wavy myocardial fibers (94.6%), myofiber fragmentation (92.9%), squared nuclei of cardiomyocytes (98.2%), and myocardial necrosis (62.5%). No statistically significant association was found between gross electrical burns and myocardial lesions, suggesting that these findings may occur independently.  Conclusions: Both electrical skin burns and myocardial lesions provide important forensic evidence in electrocution deaths. Notably, characteristic histopathological changes may still be present even in the absence of grossly visible electrical burns. These findings emphasize the crucial role of combining gross examination with histopathological analysis to improve diagnostic accuracy in forensic investigations of electrocution-related deaths.