EMBALMING THEORY 2-CHAPTER 15

Single Intradermal Suture

"Hidden stitch" used on exposed areas of the body and is directed through the subcutaneous tissues only

Ecchymosis

(Bruise) discoloration of the skin caused by the escape of blood within the tissues, generally accompanied by swelling

Surface Embalming

-Can be used to treat intact skin that has not received sufficient arterial fluid as well as broken skin areas such as abrasions, skin slip, burned tissues, and surface lesions. -Surface embalming may be applied to both external and internal body surfaces.

Closure of Incisions-Steps to Prepare for Incision Clossure

1.) Do not suture until after cavity aspiration. 2.)Be certain all vessels are securely tied. 3.)If there is edema in the surrounding tissues, force as much liquid out of the incision as possible. 4.)Dry the incision 5.)Cotton saturated with a cautery solution can packed into the incision. 6.)Make several sutures before applying incision sealer powder to the incision. 7.)After suturing, apply a surface glue over the area to prevent leakage.

Postemblaming Tasks (pg 293)

1.) Preservative treatments for areas that did not receive arterial solution or did not receive sufficient arterial solution. 2.) Closure of embalming incisions 3.) Removal (and closure of the opening) of invasive devices (pacemaker, intravenous needles, surgical drains, colostomy apparatus) 4.) Washing the body, turning the body to dry, inspect for posterior lesions. 5.) Final treatments for ulceration's and discolorations. 6.) Corrective treatments for purge and packing of all orifices 7.) Removal of gases or edema from viewable facial areas. 8.) Inspection of mouth for purge or moisture; resetting features if necessary, and insertion of false teeth if these were not available before embalming. 9.) Application of adhesives to eyes and mouth 10.) Dressing in plastic garments 11.) Terminal disinfection of instruments and preparation room and personal hygiene. 12.) Preparation of documentation, shipping instructions etc.

EDEMA OF THE EYELIDS CAN BE TREATED IN SEVERAL WAYS:

1.) Weighted surface compresses 2.)Cavity fluid on cotton under the eyelids, during and after injection. 3.)hypodermic injection of phenol compound or cavity fluid after embalming. 4.) By use of a heated electric spatula after embalming

Restorative and Vessel Raising Incisions

3/8 Inch circle needle

Select pressure/ROF. Injecting solution arterially. Massage/Manipulate body. Control drainage. Treat cavity

5 steps of embalming

Hidden and good for exposed spots

Advantages or single intradermal sutture

CARE OF EMBALMING MACHINE

After use of embalming machine it should be flushed with warm water. Ammonia and lukewarm water should be flushed through the machine to remove residue. Machine should be filled with water which keeps the gaskets moist and allows water time to release and dissolved gases such as chlorine.

SURFACES

All surfaces should be first cleaned with cool water and a small amount of antiseptic soap to remove organic debris. Bleach and warm water make a great cleaning solution. Lysol products are good disinfectants

Continuous (Whip) Suture

Anchor the suture thread. Pass the needle through both sides of the incision, starting on the outside of the tissue on one side of the incision and passing directly through and out the tissues of the opposite side of the incision. Pass the thread over the top of the incision and begin the next stitch 1/2 to 1 inch beyond the previous stitch. The process is completed when the incision is closed

LEAKAGE-Potential Areas of Leakage

Any area of trauma to the face or hands where the skin was broken or torn Cranial autopsy incisions Autopsy sutures Surgical Sutures Sutures at sites where vessels were raised for arterial injection Areas where edema is present Intravenous punctures Punctures used for drawing postmortem blood samples Any point where the skin has been broken

Use bridge suture to aline skin and begin at the pubic symphysis and suture superiorly

Autopsy Trunk Suture

Medial area of the incision laterally with arm abducted

Axillary Suture

POPLITEAL ARTERY

Begin the suture at the inferior (distal) portion of the incision and suture superiorly.

Popliteal Artery

Begin the suture at the inferior (or distal) portion of the incision and suture superiorly

Autopsies (Trunk Standard "Y" Incision)

Begin the suture at the trunk at the pubic symphysis and suture superiorly.

ANTERIOR and POSTERIOR TIBIAL ARTERIES

Begin the sutures distally and suture superiorly

Anterior and Posterior Tibial Arteries

Begin the sutures distally and suture superiorly

Internal Application of Surface Packs

Buccal cavity of the mouth -Underneath eyelids -Within the nasal cavity -Underneath the scalp in autopsied bodies -Inner trunk walls of autopsied bodies

MAGGOTS

Can be picked from the surface of the body with cotton saturated with a hydrocarbon solvent. To stimulate maggots to emerge to the surface from the areas beneath the skin or from the mouth or nostrils, areas can be swabbed with a petroleum product. Maggots should be placed in plastic bags before disposal

Maggots

Can develop after 24 hours if flys are able to lay eggs

BASEBALL SUTURES

Considered the most secure and commonly used Can be airtight Used for injection site incisions, autopsy, long surgical, and long-bone donor incisions.

Mouth/Lips

Cotton can be placed over the dentures and saturated with cavity fluid, using a hypodermic needle and syringe to moisten cotton. The lips then can be glued. Preservative works from the inside of the mouth to preserve tissues.

Nose

Cotton can be saturated with preservative fluid can be inserted into the nostrils.

Eyelids

Cotton can be used for eye closure or a small piece of cotton can be inserted over the top of an eye cap. The cotton can be moistened with a few drops of cavity fluid and the eyelids sealed with an adhesive.

Crepitation

Crackling sensation produced when gases trapped in tissues are palpated, as in subcutaneous emphysema or tissue gas.

INTERLOCKING (LOCK) SUTURE

Creates a tight, leak proof closure. It's disadvantage that an unsightly ridge appears on the surface of the incision.

Interlocking (Lock) Suture

Creates a tight, leakproof closure. A disadvantage is an unsightly ridge that appears on the surface of the incision.

Spongy feel of gas in the tissue

Crepitation

Subcutaneous Emphysema

Distention of the tissues beneath the skin by gas or air. An antemortem condition brought about by a surgical procedure or trauma

DOUBLE-CURVED AUTOPSY NEEDLE

Easy to grip with the gloved hand. Used to close autopsy incisions, long bone donors, surgical incisions, and incisions made to raise vessels.

Leakage

Escape of fluid or blood

Cotton can be used for eye closure or small pieces over an eye cap and then moistened with cavity fluid. Eyelids can be glued

Eyelid Surface Treatments

Suture from the inferior portion o fthe incision superiorly

Femoral Sutures

CONTINUOUS (WHIP) SUTURE

Generally used to close long incisions. Frequently used in autopsy technician to close long incisions on autopsy. Prevents leakage of fluids from the body cavities during transfer from the hospital to the funeral home.

Use adhesive to seal mouth and eye -make sure surface is dry, lips keep glue behind the weather line, eyes keep glue away from lashes apply to eye cap or inside like of closure

Gluing features

DISINFECTION CHECKLIST

Has a wide range of activity (works against viruses, bacteria, and fungi) Is of sufficient strength (active against spore forming organisms or bacilli and fungi) Acts in the presence of water Is stable and has a reasonably long shelf life Is non-corrosive to metal instruments Acts fast Is not highly toxic to living tissues or injurious to the respiratory system

The Mouth, Scalp Incisions (autopsy)

Hypodermic embalming if facial areas can be made through

Placed on Abdomen

If transferring the body how should hands be placed

Common Carotid Artery

If using the parallel incision, suture from the inferior portion of the incision superiorly. If using a supraclavicular incision, suture from the medial portion of the incision laterally.

CLEAN INSTRUMENTS PRIOR TO DISINFECTION

Immerse all instruments including trocars in a solution of Bard-Parker disinfectant (8% by volume formaldehyde in 70% ethanol or isopropanol) or in 200 to 300 ppm of an iodophor for 45 minutes or longer. Destroy cutting blades in biohazard sharps container

Mold

In warm climates a problem when bodies are being held for long periods

INDIVIDUAL (BRIDGE) SUTURES

Individual sutures that are used to align tissues into position prior to, during, or after embalming. They are temporary and are later replaced by more permanent sutures.

Terminal disinfection

Institution of disinfection and decontamination measures after preparation of the remains

One thread and needle/Needle passes through dermal tissue only

Inversion Suture, Single Intradermal

Worm

Inversion Suture-used to gather in and turn under excess tissues

Hypodermic Injection

Involves the use of a hypodermic syringe and needles ranging from 6 to 19 gauges and varying lengths.6 gauge (largest)-large areas

INVERSION (WORM) SUTURE

Is used to gather in and turn under excess tissues. Pattern of this suture is the same as the single intradermal suture, except that the stitches are made parallel to the incision edges and do not pierce the margins of the incision. Stitches are generally made close to the margins and possible.

Cotton or Linen Thread

Linen thread is stronger than cotton thread and is recommended for autopsy, long bone donors, and vessel incision sutures.

Cotton, Linen Thread or Dental Floss

Linen thread is stronger than cotton thread. It is recommended for autopsy and vessel incision sutures. Dental floss is used for restorative sutures, which are located on visible areas

Chemicals Used for Surface Embalming

Liquids, Gels, Powders

DOUBLE INTRADERMAL SUTURE

Made with 2 needles threaded with opposite ends of the same thread.

SINGLE INTRADERMAL (HIDDEN) SUTURE

Made with one needle and a single thread

MOLD

Make sure the body is thoroughly dried especially in warmer climates. Mold needs to be carefully removed with a scalpel or spatula. The area is then swabbed with a phenol compound chemical and later thoroughly dried before cosmetics. Placing embalming powder inside plastic coveralls, pants, and/or stockings help to control mold growth

Invasive Devices

Pacemaker, intravenous needles, surgical drains, colostomy apparatus

COMMON CAROTID ARTERY

Parallel incision-suture from the inferior portion of the incision superiorly. Suture from the medial portion of the incision laterally if using a supraclavicular incision

Excess moisture in tissue spaces

Pitting edema

Coverall

Plastic garment designed to cover the body from the chest down to the upper thigh

Unionall

Plastic garment designed to cover the entire body from the neck down to and including the feet

Purge

Postmortem evacution of any substance from an external orifice of the body as a result of pressure.

Edema, Tumors, Swelling due to Trauma, gas

Pre Embalming distention causes

Autopsy Gel

Preservative gels available in two viscosities: a gel that is thin and can be poured, and a more viscous gel that can easily be applied by brush to the skin surface.

Infant trocar,Medially above or below knee (thigh / calf)

Procedure for hypodermic embalming leg

Suture from the distal portion of the Incision Medially

Radial or Ulnar Suture

Linen

Recommended thread for autopsys

Edema in body appendages, trunk, and head

Skeletal edema

Pacemaker, IV Needles, Surgical Drains, Colostomy Apparatus

Some types of medical devices removed after emblaming

ADHESIVES

Super Glues

2 Supplemental Methods of Embalming

Surface and Hypodermic Emblaming

Suture from the inferior portion of the incision superiorly

Sutture common carotid (parallel insicion)

Suture form medial portion of the incision laterally

Suture Common Carotid (Supraclavicular incisions)

Radial and Ulnar Arteries

Suture from the distal portion of the incision medially

RADIAL and ULNAR ARTERIES

Suture from the distal portion of the incision medially.

FEMORAL ARTERY

Suture from the inferior portion of the incision superiorly.

Femoral Artery

Suture from the inferior portion of the incision superiorly.

AXILLARY ARTERY

Suture from the medial area of the incision laterally (with arm abducted)

Axillary Artery

Suture from the medial area of the incision laterally (with the arm abducted)

Brachial Artery

Suture from the medial portion of the incision laterally

BRACHIAL ARTERY

Suture from the medial portion of the incision with the arm abducted

Double Intradermal Suture

Suture is made with two needles threaded with opposite ends of the same thread

Inversion (Worm) Suture

Suture is not visible and may be waxed as needed. It is an excellent suture for for closing a carotid incision or closing the scalp on the cranial autopsy.

Bridge suture

Temporary suture consisting of individually cut and tied stitches employed to sustain the proper position of tissues

A 3/8-INCH CIRCLE NEEDLE

The 3/8-inch circle needle is used for restorative sutures and to suture incisions made to raise vessels.

Baseball suture

The most secure and commonly used, this suture is air tight

Postembalming analysis

Time period after embalming examination of body by embalmer touch up any areas

Surface compress, Hypodermic injection of phenol or cavity fluid, Electric spatula

Treating edema of eyelid

Remove bag, pour cavity fluid into bag for disinfection

Treatment for a Colostomy bag

AUTOPSIES (TRUNK STANDARD "Y" INCISION)

Use bridge sutures to align the skin into position. Begin with the trunk suturing at the pubic symphysis and suture superiorly.

Phenol Cautery Chemicals

Used for areas where the superficial layers of skin are missing

A 3/8-inch Circle Needle

Used for restorative sutures and to suture incisions made to raise vessels

Double-Curved Autopsy Needle

Used to close autopsy incisions, surgical incision, and incisions made to raise vessels

Surface Embalming

Used to treat intact skin that has not received sufficient arterial fluid

Hypodermic Embalming

Used to treat small localized areas or large areas, such as the trunk walls of the autopsied body or a limb that did not receive sufficient arterial fluid and cannot be injected arterially.

Hypodermic embalming

Used to treat small localized body areas or large areas, such as the trunk walls of the autopsied body or a limb that did not receive sufficient arterial fluid and can't be injected arterially

Keep bodies dry, Swab with phenol, Re cozmatize

Ways to prevent Mold

Excessive amounts of fluid, Rapid injection, Too much pressure, Poor drainage

What during inection can cause distention

Treatments for Areas Lacking Arterial Solution

When doubt exists as to whether an area has received any or sufficient solution, the simplest corrective treatment is to inject the area arterially

Posterior lesions, Blisters, Ulcers

When washing the body after embalming you are looking for what