Types of Incisions in Autopsy

Primary (Trunk) Incisions

1. "I"-shaped Incision (T-shaped / Midline Incision)

• Also called the straight or "T"-shaped incision in some texts
• Runs in the midline from the chin straight down to the symphysis pubis, passing either to the left or right of the umbilicus
• The umbilicus is deliberately avoided because its dense fibrous tissue is difficult to penetrate with a needle when the body is stitched after autopsy
• Simplest of the three; used when neck examination is also required

2. "Y"-shaped Incision

• The most commonly used incision
• Starts from a point close to the acromial process on both sides
• Two arms extend diagonally downward, below the breast (below the mammary line), converging at the xiphoid process
• From the xiphoid, a single midline incision continues downward to the symphysis pubis (passing either side of the umbilicus)
• Provides excellent exposure of the chest and abdomen
• Preferred in adult male autopsies

3. Modified "Y"-shaped Incision

• A midline incision is made from the suprasternal notch down to the symphysis pubis
• From the suprasternal notch, two arms extend over the clavicle to its center on both sides, then pass upward over the neck behind the ear to the mastoid process
• Preferred in females to preserve cosmetic appearance of the chest, and in cases where the neck structures need to be examined without a separate neck dissection
• Also preferred in children

Note: The incision must be modified according to the special conditions of each case. For example, in cases of stab wounds of the chest or abdomen, the standard incision must be altered to avoid disturbing such wounds before they are documented.

Scalp Incision (Head Examination)

• A coronal (intermastoidal) incision is made in the scalp
• It starts from the mastoid process behind one ear, carried over the vertex of the scalp to the back of the opposite ear
• The incision penetrates to the periosteum
• The scalp is reflected: anteriorly to the superciliary ridges, posteriorly to just below the occipital protuberance
• This creates two flaps (anterior and posterior) that expose the entire skull cap
• After reflecting the scalp, the skull cap is removed using a V-shaped saw-line running horizontally from the center of the forehead to the base of the mastoid process on both sides and then backwards/upwards to above the external occipital protuberance

Skull Cap Removal

• The temporal and masseter muscles are cut on either side
• The saw-line is made in a slightly V-shaped direction so the cap fits back precisely (important for cosmetic restoration)
• Average skull thickness is 3-5 mm; stop sawing when resistance decreases to avoid cutting the meninges
• A chisel and hammer are NOT used to loosen the skull, as heavy hammering may cause false fractures

Infant Head (Special Technique - Baar's Method)

• The Rokitansky technique is used for infant autopsies
• An incision is made into the anterior fontanelle at its posterior margin, ~5 mm from the midline
• The parietal bone is cut longitudinally parallel to the sagittal suture up to the lambdoid suture
• Bilateral parietotemporal flaps are turned outward to examine the brain

Special Situations

• The Essentials of Forensic Medicine and Toxicology, 36th edition (2026), Chapter 5 - External/Skin Incisions & Examination of the Head
• P C Dikshit Textbook of Forensic Medicine and Toxicology, Chapter 8 - Internal Examination