Preliminary study to determine the criteria that can standardize the evaluation of permanent facial scars

Introduction and Aim: In our country, permanent facial scar (PFS) is under the heading of offences against physical integrity of Turkish Penal Code (TPC) and a penalty increase would be in question in case of PFS positivity. In studies which analyze re-evaluated PFS reports, it was found that there were different opinions between a ratio of 74-78%. Such difference between reports is unacceptable in criminal cases. Distance (1-2 meters), light source (artificial/daylight) and personal characteristics of the physician performing the examination are factors that affect the evaluation of PFS. This study aims to identify objectivity parameters of PFS and to establish objective criteria for standardizing these evaluations in order to minimize the requirement of repetitive examinations and loss of rights in the trial. Materials and Methods: This study is a cross-sectional study and was conducted on 43 cases which were referred to our department by judicial authorities for PFS evaluation between the dates of 01.10.2019-30.09.2020. The patient characteristics such as patient history, sociodemographic information, and features of facial injury such as location, size, skin color, wound color, the location of the wound relative to the skin were filled in data registration forms. The wound in the facial area was examined by two physicians and photographed under artificial light and daylight, from a distance of 50 cm, 1 and 2 meters, and from the front and side. The obtained data were used to perform chi-square, fisher exact and consistency analysis in SPSS 24.0 software. Findings: In the study, 63 lesions were detected in 43 cases. It was observed that the average age of the cases was 36.65 ± 13.96, 86% were male and 14% were female. It was found that 51.2% of the cases (22 people) were injured due to blunt trauma, scars with a length more than 2 cm were statistically significantly were evaluated as a permanent facial scar (p=0,001), permanent scar decision was made more often for lesions that became evident with mimic movements compared to those that did not become evident (p = 0.001). Good/very good level of consistency was identified when consistency of separate evaluations made by the 1st and 2nd physicians under daylight and artificial light at a distance of 1 and 2 meters were analyzed according to lesion's location and color distribution relative to the skin, definitions at the first examination and evaluations made according to the skin color of the cases; while moderate and above consistency was identified for PFS positivity/negativity evaluation according to localization and mimic movements. Discussion and Conclusion: Within the framework of fair trial principle; objective criteria are required to be identified for distance, source of light and evaluating physician which are three parameters used for PFS evaluation. We think that the distance parameter, which is thought to be the easiest to be determined in terms of objectivity, should be defined more clearly in the guide. Our recommendation is to make a decision by evaluating at a distance of both 1 meter and 2 meters or to make evaluations from a single predetermined distance. We think that the most difficult parameters to provide objectivity in the evaluations of PFS are the light source and individual differences of the physician. Considering the effect of multiple factors in PFS evaluations; we think that robotic/artificial intelligence applications, which are rapidly developing/changing in our age, should also be used in the field of forensic sciences to minimize the requirement of repetitive examinations and loss of rights. Key Words: Permanent facial scar, medicolegal evaluation, objective criteria, wound healing, light source, distance