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Multiple parallel linear wounds were observed on his head. At the crime scene, an axe stained with blood and hair was found resting against the wall adjacent to the stairs leading to the upper floor. Forensic investigations identify the cause of death as mechanical asphyxia due to the hanging, in a complex suicide characterized by hesitation marks inflicted on the head with an axe. This specific type of complex suicide has never been described in the literature.<\/jats:p>","DOI":"10.1007\/s12024-025-00964-2","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T11:27:53Z","timestamp":1740050873000},"page":"1515-1519","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A singular case of complex suicide by hanging with hesitation marks by axe"],"prefix":"10.1007","volume":"21","author":[{"given":"Annachiara","family":"Vinci","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9825-1739","authenticated-orcid":false,"given":"Laura","family":"Laura Ambrosi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Benevento","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Ferorelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biagio","family":"Solarino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"964_CR1","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1097\/PAF.0000000000000503","volume":"41","author":"C Kulkarni","year":"2020","unstructured":"Kulkarni C, Mohite S, Meshram V. Unplanned complex suicide by self-stabbing and rail suicide: a case report and review of literature. Am J Forensic Med Pathol. 2020;41:78\u201380.","journal-title":"Am J Forensic Med Pathol"},{"key":"964_CR2","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1111\/1556-4029.13609","volume":"63","author":"N Ateriya","year":"2018","unstructured":"Ateriya N, Kanchan T, Shekhawat RS, Setia P, Saraf A. Unplanned complex suicide\u2014a consideration of multiple methods. J Forensic Sci. 2018;63:945\u20136.","journal-title":"J Forensic Sci"},{"key":"964_CR3","doi-asserted-by":"crossref","unstructured":"Baldino G, Vanin S, Burrascano G, Forzese E, Asmundo A, Ventura Spagnolo E. A case report of complex suicide in physician: attempt drugs poisoning and adhesive tape asphyxia. Forensic Science, Medicine and Pathology. 2024;1\u20135.","DOI":"10.1007\/s12024-024-00836-1"},{"key":"964_CR4","doi-asserted-by":"crossref","unstructured":"Marcinkowski T, Pukacka-Sokolowska L, Wojciechowski T. 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Humana Press, Totoba, New Jersey; 2005. p. 311.","DOI":"10.1385\/1592598722"},{"key":"964_CR8","doi-asserted-by":"crossref","unstructured":"Palmiere C, Risso E, van Hecke O, La Harpe R. Unplanned complex suicide by self-strangulation associated with multiple sharp force injuries. Medicine, science and the law. 2007;47(3):269\u201373.","DOI":"10.1258\/rsmmsl.47.3.269"},{"key":"964_CR9","doi-asserted-by":"crossref","unstructured":"Alexandri M, Tsellou M, Kapsali A, Ferentinos P, Tatsioni A, Dona A, ... Papadodima SA. Forensic investigation of complex and complicated suicides in Attica, Greece: a 12-year retrospective study. Forensic Science, Medicine and Pathology. 2024;1\u20138.","DOI":"10.1007\/s12024-024-00842-3"},{"key":"964_CR10","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.forsciint.2005.04.039","volume":"157","author":"G Altun","year":"2006","unstructured":"Altun G. Planned complex suicide: report of three cases. Forensic Sci Int. 2006;157:83\u20136.","journal-title":"Forensic Sci Int"},{"key":"964_CR11","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.forsciint.2008.10.020","volume":"184","author":"K T\u00f6r\u0151","year":"2009","unstructured":"T\u00f6r\u0151 K, Pollak S. Complex suicide versus complicated suicide. Forensic Sci Int. 2009;184:6\u20139.","journal-title":"Forensic Sci Int"},{"key":"964_CR12","unstructured":"Bohnert M, Pollak S. Complex suicides--a review of the literature. Archiv fur Kriminologie. 2004;213(5-6):138\u201353."},{"key":"964_CR13","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1111\/1556-4029.13146","volume":"61","author":"M-V Karakasi","year":"2016","unstructured":"Karakasi M-V, Nastoulis E, Kapetanakis S, Vasilikos E, Kyropoulos G, Pavlidis P. Hesitation wounds and sharp force injuries in forensic pathology and psychiatry: multidisciplinary review of the literature and study of two cases. 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