Photodocumentation of injuries: legal security without legal medicine?

Background: In contrast to the social and legal demands for low-threshold medico-legal infrastructures, nationwide access to services for the collection and documentation of evidence does not exist in Germany to this day. In this context, digitalization and the expansion of telemedical services have an increasing impact on the specialized care for persons affected by violence and/or abuse. Technical progress, however, facilitates not only the communication and documentation but also the manipulation of medical results.Objective: Relevant medico-legal findings can be manipulated by faking injuries directly on a person's body and by editing the digital photograph. Thus, the reliability and authenticity of photographically self-documented injuries should be challenged and doubts about whether such a procedure can replace medico-legal examinations and meet forensic standards as evidence in court trials arise.Methods: The possibilities, limitations, and pitfalls of the self-documentation of wounds and injuries are discussed and demonstrated with the aid of real case examples, self-experiments as well as photographs that have been digitally processed using the app Procreate (R).Conclusion: Widely available online instructions and simple techniques facilitate the manipulation of medico-legal findings. As the results appear remarkably realistic, the risks of assessing such evidence in any legal proceedings must be taken into account, especially in the absence of mandatory protocols regarding the validation and error analysis of digital information processing. A closer look confirms that the direct physical examination by a forensic medical specialist cannot be replaced by digital means at present.