Hi gang,
I am a trauma/burn/neurosurgery/general surgery critical care nurse. I see all sorts of trauma wounds, burn related wounds, plastics, orthopedics and vascular wounds. I am not overly familiar with cosmetic procedure scarring or less serious surgical scars.
My thoughts:
First of all, the description of these scars have been inconsistent, describing both ankles as surgical scars, then the left ankle only, no mention of the L scar on the namus profile, both legs having calf scars and then the right only, etc.
Secondly, I do not (obviously) have access to the autopsy report or photos of the scars, so it would be virtually impossible for me to say with any degree of certainty what the scars are from.
Thirdly, I have no idea if the info we have been given is complete or incomplete. There is no mention of abnormalities on xrays, no mention of non linear scars, track marks etc. Therefore these are either a) non-existent or b) being deliberately withheld, although I don't see how withholding info about possible remote injuries would assist in identifying her.
With that said, these are the things I can say:
1) These have only been described as scars. Scars indicate the injury or surgical site has HEALED, and therefore precede the the incident that caused her death. Likely by a month or so at minimum.
2) I strongly feel these are not fasciotomy scars due to the short length of them. The only one that could potentially be one by location alone is the 3.5 inch scar on the inner side of the L calf muscle. However, it is much too short.
3) These are unlikely to be trauma related. When I say trauma related I mean major trauma, such as an MVA. There is no indication of healed breaks on xray. There is no indication of hardware found on xray. Therefore these scars are likely unrelated to a fracture.
4) the medial ankle scars could be related to surgery for an entrapped nerve or damaged tendons, ligaments. Couldn't say for sure without seeing them.
5) The calf scars annoy me, because the right one is described as posterior, then later described as lateral. So if they are surgical wounds I can't say what they are. If they were both posterior but mid calf I'd say potentially a calf reduction surgery. Laterally? I don't know. Unlikely to be major vascular surgery related, because I have yet to meet a vascular surgeon who doesn't perform without at least an 18" incision. I suppose venous congestion or varicose vein surgery is possible.
6) The L shaped scar on the shin has me stumped. L shaped surgical wounds could be a flap procedure, but from the shin, rather unlikely. It's not a thigh plasty because it's on the shin. It could be a graft donor site but those tend to be rectangular, and surgeons tend to prefer the thigh for donor sites. The L shape could also be consistent with a healed skin tear. I'd really have to see this scar to really make any educated guesses.
7) all of these scars, surgical or otherwise, could be related to lacerations obtained by whatever means instead of a planned surgical procedure. They could have been self injury marks, burn marks, "minor" trauma (ie: not involving a fracture), the result of being hit with some sort of shrapnel or debris like glass. The could also be excisions or surgical drainage of an abscess. Surgical drainage of an abscess is possible I guess if the woman were injecting caustic substances. However, there's no indication of any track marks or damage to the thighs, which would be the first place someone self injecting would go for on the legs. I lean against shrapnel or debris lacerations as well for the same reason, no damage or scarring on the thighs. Without indication on the shape of the scars, I couldn't rule out venous ulcers either.
My sense, based on scarce information, is we are looking for either:
1) a runner/jogger who has required surgery for running related tendon etc injuries, possible other athletic interests
2) a woman who wears high heels a lot, causing potential damage to tendons, nerves etc
3) any other of the 3-4 billion other possible females.
4) If I had more info about the painted toes it might give us more clues as to who we are looking for. Are they done by amateur or is it a professional manicure with cuticle care?
I'd be interested to see what some other medical professional has to say, if they have other ideas. But without further descriptors of the quality, direction, shape and location of the scars, I'm not sure anyone could say with certainty. I'm actually surprised the ME wasn't able to determine some possibilities. That leaves me scratching my head.