Histological and biochemical evidence for an intravital stab wound on Ötzi´s right hand

On careful re-examination of the mummy a small irregularly shaped 3.7 cm long, deep, dark brown coloured stab wound was detected on Ötzi´s right hand extending from the palmar hand to the lateral back of the hand. Since it was unclear whether this wound had happened during lifetime or whether it was a postmortal artefact, we performed a histological analysis including histochemical staining for haemosiderin deposits (on Prussian blue stains). The fat tissue revealed cord-like inclusions of an amorphous, autofluorescing material with isolated focal haemosiderin pigment droplets in Prussian blue staining without intact erythrocytes. This amorphous material was then isolated by laser based microdissection, dissolved and tested for the presence of haemoglobin. A Guaiac-based test confirmed the presence of a blood clot. Our investigations indicate that the Iceman suffered from a vital stab wound of the right hand. Typical bleeding into the subcutaneous fat tissue and the initiation of transformation of the blood clot into haemosiderin could be demonstrated. Since forensic medical practise suggests the occurence of haemosiderin containing macrophages in skin wounds between 3 to 8 days after affliction, we strongly suggest that the injury happened a few days before his death. At present, we do not know if this skin wound may have happened simultaneously or shortly after Ötzi was hit by the arrow, but if so this would suggest that he survived the attack for a few days.