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Background Despite numerous studies and publications, there is still a common expectation that a medical assessment can confirm or rule out child sexual abuse (CSA). The truth is that CSA can never be ruled out and can seldom be confirmed on clinical grounds. Aim The objective of this article was to suggest which aspects to consider when the expert medical witness in a CSA case needs to explain why CSA can seldom be confirmed and can never be ruled out. The importance of a sound medical and medico-legal history was discussed because the history was generally the only positive ‘finding’ of the assessment of children who have possibly been abused. Method Authoritative sources were used to support the explanation of reasons for an absence of corroborative clinical findings in CSA, as defined by the World Health Organization. The authors structured the individual sections by providing a background on which to base the testimony. They then summarised the clinical forensic significance of the information which should be offered in the courts and which should reflect on the court records, to be taken into account in the eventual decision, which will be made by the court. Results A guideline was provided for answering questions frequently posed to the expert witness in child abuse cases where there were no positive findings. Conclusion A structure for the explanation of reasons for a normal clinical examination when evaluating children who may have been sexually abused may reduce the discomfort of medical witnesses and improve the quality of expert medical testimony.

The prosecution of rape cases is difficult due to the absence of eyewitnesses. McCauley found that the detection of vaginal lacerations increased from one in 24 to 14 in 24 in reported adult rape cases when toluidine blue was used. Proof of injuries consistent with sexual penetration adds significantly to the evidentiary value of the medico-legal testimony. Although rape is not a clinical diagnosis and there are no diagnostic criteria to confirm rape, the possibility of genital injury during rape far exceeds the possibility of injury with consensual intercourse. If a complete examination, including the use of toluidine blue, is not used a rapist may walk away to rape again, while the victims remain with the stigma that they may have made a false allegation. Toluidine blue is a basic thiazine metachromatic dye. It has a high affinity for acidic tissue components, thereby staining tissues rich in DNA and RNA. The epithelium of the external genitalia does not have nucleated cells and prevents contact of stain with nuclei. Where the epithelium is damaged and the underlying nucleated cells are exposed, the nuclei stain blue. Injuries sustained during genital penetration show a distinctive distribution.Toluidine blue stain is easy and safe to use, available, inexpensive and does not interfere with other medico-legal evidence, therefore it is recommended to be used in the examination of all cases of alleged rape.

Do we miss half of the injuries sustained during rape because we cannot see them? An overview of the use of toluidine blue tissue stain in the medical assessment of rape cases JM Kotzé & H Brits To cite this article: JM Kotzé & H Brits (2018) Do we miss half of the injuries sustained during rape because we cannot see them? An overview of the use of toluidine blue tissue stain in the medical assessment of rape cases,

Mobile phones have progressively become an inseparable partner to plastic surgeons in their clinical practice. From using the mobile phone camera to take pictures of injuries and sending those for instant advice, to searching for the best evidence articles in peer review journals, mobile phones have changed the plastic surgeons' approach on the best way to manage their patients. The availability of information in mobile technology has allowed a growing market for education tools for plastic surgeons and patients and the use of social media for marketing purposes. With the increased availability of smartphone applications, these devices have the potential to be an invaluable tool for the modern in training and practicing plastic surgeon.