Some cases may require further evaluation including a posterior neck and back dissection.
This case involved a 12-year-old African American child who was strangled. Dissection should be done in a layer-by-layer fashion until the surface of bone is exposed.
It is important to dissect the arms as well, which may demonstrate contusions from being held during a struggle. There were no hemorrhages found in this case.
It is often more difficult to externally visualize contusions in darker-skinned individuals.