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Tips
and Techniques
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WHY
EMBALM?
There is confusion
among many concerning why embalming is
done. Among funeral licensees, it is
likely that the definition of embalming may be as varied as the number
asked. Good definitions may be given but
they may not adequately tell what is done and why it is done. In keeping with changing technology, it is
also necessary to update the definition and relate it to current
practice and
requirements. The following attempt at a definition of embalming is
based on
such criteria. (Embalming is the process
of sanitizing and preserving humane remains to render them as safe as
possible
for handling while retaining naturalness of tissue for funeral viewing
purposes.)
Sanitation
has always been a basic concern in the
rendering of funeral services. In the
early days, embalming was preformed for public health reasons. People were born, they lived, they became
ill, they died, and quite often, were embalmed in their residences. Besides embalming the dead, the funeral
licensee also fumigated and decontaminated the sick room.
In 1897, Dr. E. Myers and Prof. F.A. Sullivan
stated in their textbook of embalming: “Embalming is practiced chiefly
for two
reasons, preservation and sanitation. In a
later textbook, Dr. Myers stated: “Bodies were formerly embalmed mainly
for
preservation. Today, (1908) they are embalmed as a sanitary measure as
well,
which requires a knowledge of sanitation.”
The early schools of
mortuary science stressed the
subjects of bacteriology; sanitation, preservation, disinfection
treatment of
infectious and contagious diseases, etc. and those courses are still a
part of
the curriculum in the present-day schools. Micro-organisms,
especially “opportunistic”
pathogens, are potentially
as infectious today as they were years ago. Many
antibiotic drugs are becoming less effective
against certain
bacteria strains that seem to build resistance toward them. The preparation room, as well as the
environment of the entire funeral home, can present a higher than
normal risk
to those who come in contact with or handle dead human remains.
Bacteria simply do not
die when the host dies. The work
accomplished in 1968 by Maude R.
Hinson, a medical research librarian, documents this fact. The report
provides
many references in the scientific literature that relate to the
infectious
nature or “pathogenicity” of unpreserved or unembalmed tissue. Unembalmed tissue can become an excellent
culture medium for the growth of bacteria.
The sanitation aspect
of the embalming process was one
reason for the wide acceptance of embalming in this country. It is of interest to note the following
evaluation for embalming:
“In the disposal of
the dead, that process is most
natural, most scientific…which protects the living from disease, death
and
anguish of soul.”
This is from a
manuscript, “Embalming and Embalming
Fluids” dated 1896, by Charles W. McCurdy, Sc.D., Ph.D., prepared as
partial
fulfillment for the doctoral in Chemistry. Dr.
McCurdy, a college professor, had no funeral
service background. Dr. McCurdy also
states: “All nations, it
matters not whether pagan, Christian, Monotheistic, or Polytheistic,
unite upon
common ground of post-mortem veneration; and, as far as my reading and
observation have extended, I have yet to learn of any people, however
remote
their antiquity, however rude or wild their existence, that have failed
to
observe sepulchral rites with more or less solemnity…And so the
disposition of
the dead in all ages, whatever may have been it’s form, however crude
and ugly
may have been the preparation, has always been attended with a certain
degree
of respect for the living and sacredness for the deceased.
Some conception of religious rites and
ceremony seems to have imbued the race from the beginning; its birth,
in many
cases in form only, stripped of its faith and significance, meaningless
in the
extreme.”
Much has been written and documented
regarding the positive values of viewing casketed remains.
Psychologists, psychiatrists, members of the
clergy, etc., within funeral service as well as outside funeral
service, have
presented results obtained from actual studies that establish
emphatically the
relationship between viewing remains and the triggering of the grief
therapy
process. Such scholarly discussions
point to the emotional needs that must be fulfilled by those who suffer
a death
in their family.
Depending upon local ethnic customs,
it is not unusual for the family of the deceased to touch, embrace or
even kiss
the remains. Consequently, the remains
must be prepared in such manner that preservation and sanitation are
accomplished. The potential hygienic
hazard inherent in unembalmed remains is real.
Since the viewing of the remains is
important for such reasons, a special responsibility is imposed on the
matter
of proper preparation of the remains. Unless
this is done, that is, embalming, it is not
possible to assure
that decomposition changes such as odor and adverse appearance of the
body can
be prevented.
Many ask, just what is embalming?
How is it done? What
does it involve? How do you know it is
effective as a
sanitizing process?
Perhaps
the best way to try to answer
such questions is to relate the process of embalming to something that
is
readily known and understood. In a way,
embalming involves the same procedures used in blood transfusion, and
dialysis
exchange in artificial kidneys. The
blood is removed from the body and is replaced with chemical
preservative and
sanitizing components in solution commonly known as embalming fluid. The fluid is injected through the arterial
route and the blood and body fluids removed by way of the venous system. Through training and experience, the funeral
licensee learns how to proceed when faced with the various pathological
conditions present, and the materials he must use to preserve and
sanitize the
remains and retain naturalness
of the tissue for funeral viewing purposes.
In the process of embalming, a
suitable artery (carotid, femoral or axillary) is located through a
small
incision and usually the accompanying vein is used for drainage. Since it is not always possible to assure
that the arterial injection will thoroughly and adequately preserve and
sanitize the contents of the internal organs, a separate incision is
made at
the abdominal area for treatment of the contents of the abdominal and
thoracic
cavities.
The present operative procedures have
evolved from the early teachers during the latter part of the 19th
century and through the 1920’s and 1930’s. One
of the better known technical reports on the
subject of “Embalming:
Indefinite Preservation of the Body,” was that described by Dr. Edward
Francis
of the U.S Public Health Service, Reprint No. 292, Public Health
Reports,
vol.30, Washington, D.C., (1915). Dr
Francis actually prepared some 30 remains that he maintained for
periods of
from 4-7 weeks at 98degrees F after embalming to establish that it was
possible
to obtain preservation of remains for “indefinite” periods of time. He states in his report “these bodies
excelled in the matter of preservation, firmness, and natural color of
the
tissues.” His technique consisted of
using multiple points of injection of fluid.
The preceding reference is of interest
because it alludes to the matter of how long embalming lasts. Also, it should be mentioned that in the
northern states, beginning sometime in November, the ground becomes
frozen and
it is not possible to bury underground until the spring thaws some 4 to
5
months later. Prior to burial in the
Spring, it is not unusual for the families to request a final viewing
of the
remains. Another related fact is the
embalming of the war dead in Viet Nam.
All remains were embalmed in Viet Nam
prior to return to the U.S. Often
the interval between death and viewing
of the remains in the U.S.
was 2 to 3 weeks or longer. According to
military reports, some 80% of the remains prepared in Viet Nam
were
in condition suitable for viewing.
The study performed by Hockett, Rendon
and Rose at Wayne
State University
employed the techniques described by Dr. Francis in the above report. His procedures were updated to include
sanitation as well as preservation of remains. It
was also required that the remains used must be
in condition suitable
for viewing following the embalming and bacteriological testing
procedures. Tissue samplings were taken
to determine the number of bacteria present prior to the embalming
treatment. This established the
microbial density in the areas tested. After
embalming, another series of tissue samplings was done to determine the
number
of bacteria remaining.
This study indicated that in excess of
95% reduction in the bacterial population had been accomplished. The work performed by the Snell Laboratories
also has revealed that when embalming compositions are used in proper
concentration, sufficient volume and are applied properly, the
bacterial
populations can be reduced in excess of 95%. Thus,
these two independent studies confirm that the
embalming process
is effective in reducing hygienic hazards potentially present in dead
human
remains.
Above
references from the Champion Expanding Encyclopedia of Mortuary
Practice.
[Back to top]
Stabilization of
Mandibular and Craniomaxillofacial Trauma
A
number
of years ago I found myself becoming increasingly frustrated when
confronted
with the task of repairing a case who had incurred excessive skull
and/or
facial trauma. By facial trauma, I am
speaking mainly of cases which have received massive blunt force
injuries due
to high velocity traffic collisions and the like. There
are many dynamics when working with
this type of damage. However, I would
like to speak specifically of the various bone structures and what can
be done
to stabilize them. This is important
because all of the soft tissue repair, wax, make-up and lighting that
you use will
mean little if the skull is lopsided or the face is flattened and
disfigured.
Embalmers
and Reconstruction specialists have only been given a limited amount of
items
to correct injuries that can, at times, seem overwhelming.
As I am sure most of you are well aware, calverium
clamps and wire cannot always produce optimal results. This
is where the frustration began to
develop for me. This may sound a little strange, but after dealing with
many of
these cases I began to wonder, “What would an orthopedic surgeon have
done?”
(Assuming the person had not expired of course.) After
a little on-line research and a few
trips to the library I began to learn about Internal Orbital
reconstruction,
Nasoethmoid repairs, and Maxilla, Mandibular stabilization. One of the things I had found was that
reconstruction in the medical environment is done in large part with
what is referred
to as “Orthopedic Hardware”. Much of this
hardware consists of Titanium Micromesh and Plates which are not only
hard to
find, but obscenely expensive. What I
would like to do is explain how these items can be reproduced for very
little money
and if utilized correctly, create outstanding results.
First,
you will need to make a trip to the local hardware supplier to pick up
a few items (Fig. 1)
Self
Adhesive Aluminum Repair Patch (Usually comes in 6”x6” single sheets.)
Metal
Tie Plate. (These are pliable yet strong and can be cut to various
sizes with
Tin Snips.)
#3
and/or #4 Zinc Planted metal Eye Holes
#4 x 3/8
Flat Head Metal Screws
Small
Portable Dremel with 1/16 Drill Bit
Small
Needle Nose Pliers and Phillips Head Screw Driver
Figure 1
I cannot emphasize
this enough;
OBTAIN THE PROPER AUTHORIZATION TO DO ANY AND ALL REPAIRS PRIOR TO
BEGINNING
ANY PROCEEDURES.
More
often than not, when a case has received a high impact injury to the
face,
there will be a tearing away or splitting of the soft tissue. This can work to your advantage, as will a
cranial post because it will allow further access to the damaged areas.
One of
the first considerations for the embalmer will be whether to inject the
case
prior to performing the reconstruction. This
is open to debate because pre and post
injection of the case can
have its individual advantages. This is
a choice that will need to be made by the embalmer based on their
personal
preference end experience. I choose to
inject the case before conducting the restorations with a mild solution
that
will allow preservation but not fix the tissue in place.
For obvious reasons, you will want the tissue
to be as malleable as possible. This will
also allow for the assessment of damage to the vessels and the level of
distribution you have. Areas that have
not received sufficient fluid due to tearing away such as the nose or
flaps of
skin can then be hypodermically injected with a small 19 or 20 gauge
needle.
Let’s begin
with one of the simpler repairs, a mandibular fracture.
Because of the prominent position of the
lower jaw, mandibular fractures are the most common fracture of the
facial
skeleton. The stabilization of the lower
jaw can usually be done through the use of wires or suture ties around
the
teeth. There are times though, when the
teeth have been broken away or have been dislodged, rendering them
unsuitable as
anchor points. Or, perhaps, the jaw has
sustained multiple fractures. I have
found the use of metal plates to join the fractured ends quite useful
in
providing structure to this bone (Fig. 2). The
procedure is really quite simple as the lower
jaw, with the
exception of the Ramus, is quite accessible through the opening of the
mouth.
Figure 2
Now, we
move to maxillary fractures. The
maxillary with its adjacent bones are responsible for the structural
support
between the cranial base and the occlusal plane. The
reconstruction of the maxilla is
imperative as it serves as a support of other features, such as the
orbits and
the nasal bone. The separation of the
maxillary is what is known as a “Lefort” fracture.
These fractures are classified by stages 1, 2
and 3. For this example we will talk
about a stage 2 fracture. This is a
complete separation of the bones isolated to the central midface from
the
cranium. (Fig. 3)
Figure 3
Due to
the extent of this damage, it will be necessary to employ the
separation of
some of the soft tissues from bone surfaces. Again, it is paramount that you
have the proper signed authorizations before proceeding.
You will need to carefully incise the
tissue behind the lower eyelid so as to separate the upper edge of the
orbicularis
oculi muscle from the bone of the lower rim of the orbital. A shallow incision will be sufficient.
This
is most likely going to be the attachment point where the orbital rim
of the
maxillary bone will join with the orbital rim of the zygomatic bone.
The
flexible mesh can be layered to the desired thickness.
Using a 1/16 bit on the Dremmel, drill two
small holes into the bone and secure the mesh with screws. (Fig.4) Now that the mesh is in place and the
fracture has been stabilized, draw the tissue back into place and seal
incision
with Alpha Arron.
Figure 4
It is
also common with this kind of trauma to find the maxillary split down
the
middle just below the vomer. The metal
plate can work well for the reattachment of the halves at the gum line. (Fig. 5)
Figure 5
Another
structural challenge you may need to deal with regarding this type of
injury
will be crushed nasal bones, including the surrounding areas. (Fig. 6) If the damage is closed the reconstruction can
be done quite simply with the packing and shaping of Inr-Seel through
the nasal
passages. However, an injury of this
type that has sustained missing soft tissue can present new challenges.
Figure 6
Many
times when the nasal bone has been crushed you will need to draw
together the
inner edges of the orbitals with wires. (Fig.7)
Figure 7
Once the
area is stable, aluminum mesh can be shaped to form a foundation for
the nasal
bridge. (Fig.8) There is no doubt that
the person doing the wax reconstruction of a case with trauma of this
kind will
need to be skilled. But their job can be
made much more effective if you are able to give them a nasal skeletal
framework to build from.
Figure 8
I
understand that techniques of this kind may seem daunting and can
require a
tremendous amount of time and effort on the part of the person who has
obligated themselves. As most of you are
aware though, there are times when the family and friends of the
deceased want
the situation corrected by whatever means necessary.
I cannot help but feel that all too many
times we must suggest a closed casket due to a lack of repair options
when it
could have been an open casket with viewing if only we were able to
expand our
abilities with a small amount of ingenuity. Please
do not misunderstand; I by no means suggest
that this is due to
laziness or disregard on the part of the technician.
If fact, I feel quite the opposite.
We unfortunately have limited products at our
disposal and our methods of reconstruction are highly outdated when you
consider the modern resources available. It
is up to us to find these new methods and
techniques if we want to
move forward in our field. We just have
to be willing to look.
[Back to top]
The
Repair and Preservation of Tissue Harvested Cases
The
repair of a case that has undergone the process of tissue harvesting,
be it the
bones of the arms, legs or sometimes skin, can present various
challenges to
the embalmer. This is a topic that is
not generally a part of the curriculum in most mortuary colleges, which
is
likely due to the infrequency of this situation for most embalmers. This frequency or infrequency of cases that
have undergone tissue harvesting will weigh heavily on the geographic
location
of the funeral home, surrounding population, and the proximity of
medical
research facilities.
With
the majority of these cases, I am usually told by the funeral home
management
that the deceased would only be viewed for a day or two and that they
would
understand if proper preservation of the extremities would not be
possible. Strangely, it was as if they did
not have any
expectations for the case to be done correctly. Thorough preservation
of the
extremities without excessive leaking is possible, and a viewing for
the family
and friends of the deceased for more than a couple of days can, and
should be
an option for them.
To
begin, all of the temporary sutures in the arms and legs along with any
gauze
packing will be removed. Be sure to
check deep into the lower abdominal areas. Any
supports which have been pre placed, such as PVC
forms will be
removed and washed. Set them aside for later use. You
will now want to embalm the head,
injecting not only up into the right carotid artery but also up into
the
left. Depending whether the case had
undergone an autopsy or not, the embalmer will follow the same protocol
required to inject the head as would be done if the case not undergone
harvesting.
The
arms will be first. With rare exception,
the only bone that is generally harvested from the arms will be the
humerus. The
incision will extend down the lateral side from the shoulder to the
elbow. Due to the process of this
procedure, there
will be no vessels available to inject. Start
with the hands and fingers. They will need to
be hypodermically
injected preferably using a 6”-18ga. needle and working though the
underside of
the wrist. Moving up to the forearm, a
6”-13ga needle with a 60cc syringe will work best. For the shoulders
and upper
back, I prefer to go through the incision in the upper part of the arm.
Working
downward and fanning out you should be able to reach the entire area.
It is
very important to use a shallow angle with the trocar so as not to
puncture
tissue of the back. For now, the incisions in the upper arm will be
left open.
We
now move to the legs. The incision will
usually extend from the inside or dorsal surface of the foot, then up
the
inside of the leg. At mid-thigh, the incision will wrap around to
the
front and
then continue to the lower outer quadrant of the abdomen.
The feet and toes will be injected the same
way as the hands and fingers were. At
this time, the head, hands, forearms and feet should be properly
injected.
The
abdomen and chest will now be aspirated and followed with the
introduction cavity
fluid. This will be done as you regularly would through the stomach
just above
the naval.
The
next step will care for the unembalmed upper arms and legs.
NOTE:
You will want to make sure that you have
plastic sheeting on hand to cover the body. (I've
found that using one of the thin plastic
covers used for the
shipping of caskets from the manufactures ideal.) It
is very important that not only you, but
anyone in the vicinity use their respirators. If you have not
already
done so,
turn on the ventilation system. Using
roll
cotton or absorbent cloth, the voids of the upper arms will be packed
loosely
and clipped shut with towel clamps. The
same will be done for the full length of the legs.
If skin has been harvested from the abdomen
or back, a thin layer of cotton should now be placed over affected
areas. Preferably using an odorless cavity
fluid,
saturate all cotton in the arms, legs and those covering the areas
where skin has been
harvested. You will want to get the
plastic
cover over the body and the table as fast as possible. Until this is
done,
the
fumes will be very strong.
The
chemical packs should be allowed to work over night. This will not only
give
the fluid the ability to deeply permeate the tissue, but also allow any
residual fluid from the hypodermic injection of the back to drain
through the
shoulders. After the required amount of
time (8hrs+) with the ventilation running, you will be able to finish
the procedure. Again, wear your
respirator.
Have
a plastic biohazard bag open next to the table. Take
the plastic cover from the table and
quickly remove the towel clamps from the arms and legs.
Pull out all cotton and dispose of into the
biohazard bag, then tie the bag closed. Immediately
rinse the body of the chemicals including
the open voids of the
arms and legs and towel dry. Your case
should now be well embalmed. You
can now replace the PVC supports into the arms and legs that had been
removed
earlier. Starting at the lowest point of
the incision on the foot, begin a tight baseball stitch and work upward. (Use your towel clamps to hold tissue in
place while working.) Stop about every 8
to 12 inches and tightly pack hardening compound into the pocket that
will be
created as you suture. When you get up to
the hips,
make sure to pack any voids around the lower abdomen. The
same steps will apply to the arms, sewing from
the elbow and up to the shoulder.
As
a final step, all incisions should be brushed with a sealant and
allowed to
dry. I
realize that this procedure is a bit lengthy and does require a
large
amount of work.
You the embalmer, are going to need to make a decision
as to
whether or not this is something that you are prepared to commit to. What I can tell you however, from my own
experience, is that this procedure will extend the amount of time that
you are
able to offer the family and friends of the deceased. Which will
allow further time for them to carry out their
affairs. That will make all of your extra efforts greatly worth
while.
[Back to top]
Infant
Heart Injection
When
embalming an infant, there are many factors to consider. Some of
those being the proper pressure, flow rate, fluid index and the
incision site. The location of the incision is very important for
many reasons. Not only will this have a direct affect on the
distribution of the fluid, but more often than not, the parents will
likely want to hold and touch their infant. For this reason, we need
to conceal and keep the incision to a minimum. The carotid arteries
should be avoided at all cost. The femoral arteries can be used but
the distribution can be questionable.
To
begin, a thoracic incision will need to be made in the center of the
sternum. This incision will be a crescent measuring approximately 2
inches from top to bottom. (Fig. 1)
The tissue will then be cut away
from the
sternum creating a flap of skin. Fold the skin to the side and cut
away the exposed area of the sternum with your scalpel. The extracted
piece of bone will resemble a D shape and roughly match the size of
the skin flap. (Fig. 2)
The
pericardial sack will now be exposed. A shallow incision should be
made to cut away this sack and the heart will now be visible. With a
forcep, grab the apex of the heart and gently lift upward and down so
as to partially extract the heart from the thoracic cavity. The flat
end of an Aneurism hook can be slid behind the heart for support.
Care should be used so as not to damage the aorta or pulmonary
arteries. (Fig 3)
While
holding the heart, insert a small curved arterial tube through the
wall of the left ventricle in the direction towards the aorta so that
the end of the tube lies within the chamber of the ventricle. No
incision will be made for the insertion of the tube because as the
muscle of the heart will create a tight fit around the tube. A small
incision will now be made in the right ventricle for drainage. A
pair of spring forceps can hold the incision open. (Fig. 4)
Care
should be used so as the quantity of arterial fluid injected does not
exceed the amount of drainage to avoid swelling. One quart to 3
pints of a mild arterial solution should be injected. Injection
pressure should not exceed 1 to 1.5 pounds and the rate of
flow should be a minimum.
There
is no reason the close the incision in the right atrium or puncture
in the left after arterial injection is completed. I prefer to
aspirate at this point as there is already a hole in the chest that
can be worked through. Cavity treatment should be done with 6 to 12
ounces of concentrated low-odor fluid. The heart is now placed back
into the thoracic cavity, the sternum bone is returned to its
original position and the incision is closed.
A
small amount of sealant should be used along the suture as insurance
against any leaks and a small 3x3 flesh tone bandage will complete
the procedure. (Fig. 5)
If this is done correctly, optimal
distribution will
be acquired with a minimum of disturbance visually.
[Back to top]
Rigor
Mortis and Its Effect on Embalming
It
is important to understand that different tissues take up
embalming fluids
at different rates of speed. The viscera, muscle, skin and arterial
walls, in
that order, have the greatest uptake of fluid. Rigor mortis
affects the
amount of aldehyde taken up by the tissue. During rigor
mortis, the
tissue may not appear to absorb very much of the injected
solution. Sometimes it can be almost impossible to inject very
much
solution without causing swelling, especially when high pressures are
used,
and here is why.
The
blood vessels are contracted like other muscular tissues, so their
diameters are reduced in size. This obstructs the flow of the embalming
fluid. For this reason, the tissue is not in its best condition
to
receive the fluids. It stands to reason that the ideal time
to
embalm would either be before or after rigor.
Breaking
rigor by flexing the body has the effect of increasing the amount of
preservative that the tissue will take up. This is due to a
breakdown of
protein that results from the process of flexing the
muscles.
As the proteins break down into simpler units, each unit will take up
additional amounts of the preservative. If rigor is allowed to
pass
without flexing the body, the tissue will have increased after the
injection of
fluid. This, again, is due to the normal breakdown of protein
structures
so that more groups are available to take up the preservative. At
times, the embalmer is not aware that rigor has begun to develop
when starting to
inject the embalming solution. Sometimes, the injected fluid has
the
effect of producing a "shock" when it starts to contact the
tissue. As a result, this appears to accelerate the onset of the
rigor
mortis.
Because
of this, what the embalmer thinks is firmness due to the chemical
reaction of
the injected fluid is really due to the rigor mortis. If
he has
injected two or two and a half gallons of fluid, by the time he has
noticed
this state of "firmness" he probably figures the body is embalmed and
stops injecting. A few hours later, he will probably find that
the
embalmed body is no longer as firm
as it was
when it was first embalmed. Eventually, the body may even
become
soft. [Back to top]
Re-Attachment
of a Severed Limb
The
ideal situation would be one that presents large viable arteries that
are still
intact at the end of the limb. Once you have located these arteries,
you can
begin injecting the limb using a low pressure limited amount of flow
because
you do not want to create swelling. After injection has begun, you will
notice
the leakage of fluid from smaller surrounding arteries. These arteries
should
be clamped off with locking forceps or artery clamps. If you do not
have enough
of these clamps available, tie tight ligatures around these vessels,
but be
sure to leave the veins unobstructed so as to mimic the natural pattern
of circulation
and promote drainage. If
you
are injecting the leg, and you find that the larger arteries are
destroyed at
the amputation point, the leg can also be injected by way of the
posterior tibia. The severed end will, as
soon as injection
starts, indicate the location of the severed vessels by means of
leakage. Once
located, legate them. A severed arm can
be injected through the brachial artery or the radial artery. Whether you are working with the leg, or arm,
the severed vessels on the stump should be legated and the body will be
injected
as it normally would, by way of the carotid or axillary artery in the
uninjured
arm or the femoral in the uninjured leg.
Several
hours after the body is thoroughly embalmed, the limb and stump should
be
fastened together by stitching and splinting. Splints
for the fleshy part of the limbs can be made
from small metal
rods. As crude as it may sound, I have found that metal “kabob” skewers
sharpened at each end work exceptionally well for this as they can be
inserted
easily into muscles of the stump and the severed part of the limb. I
suggest
using at least three of these splints. Once the splints are inserted
and the
limb is reattached to the stump, loose tissue should be excised and a
clean,
tight baseball suture should be used to secure the two ends. Once attached, the suture line should be
coated with a thick layer glue and a cotton webbing wrap should be
applied. This would then be followed with
a plastic
sleeve as added precaution against leakage.
[Back to top]
Alternate
Method For Calvaruim Closure After Embalming a Posted Case.
By: Michael S. Bryant,
KY Licensed FD/Embalmer
This is a method that I introduced to my colleagues and
have found it to work with great results, i.e. No leakage and secure
cranium. Our
funeral homes are high volume. This method is something that I had not
read or
heard about prior to trying it. One day I was setting features on an
autopsied
body and I had to use denture adhesive to keep the persons dentures
from moving
or shifting in their mouth while I secured the mouth closure. The
denture
adhesive was somewhat messing and had oozed onto the lower natural
teeth, it
was a chore to remove it (the stuff is made to be in a moist
environment .)
Needless to say I couldn't remove all of the adhesive. I had used the
needle
injection style of mouth closure, and as I was meeting the upper and
lower jaws
together, prior to twisting the wires the teeth had came together and
stayed
together from the denture adhesive that was still remaining on the
lower teeth.
After injection was done and I was restoring the body to its pre-posted
look.
CLICK..The light went on and I decided I would try putting the denture
adhesive
on the calvarium and see if this bead would hold like it did on the
teeth.
Trial and error...It worked!
This is
how I did it..
- Be
sure to dry the marginal tissues of the scalp and remaining fibers and
muscles on the calvaria with a phenol based cauterant chemical.
- Prep
the Cranial Cavity as you normally would.
- Dry
off the cut-line bone surfaces of both the calvaruim and the skull with
cotton or towel, be sure to use caution on bone edges, they may be
sharp.
- Apply
a liberal, continuous bead of any brand of DENTURE ADHESIVE to just the skull cap
(calverium) cut-line.
- Line
the skull cap up with the skull and with slight pressure, press the
calvarium directly onto the skull. Wiggle calvarium from side to
side slightly to be sure it is adhered properly.
- Hold
calvarium in place for a few seconds.
- Using
your finger smooth the excess denture adhesive around the bone to bone
contact cut-line filling in any spaces.
- Apply
autopsy gel to the cranium, pull the scalp back, and suture as you
normally would.
I use
this method on
every posted body I embalm. I feel this works well for me and my
colleagues.
Have yet, Knock on wood, had a leaky head. Good luck...Hope this helps.
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