RA II Final

Define abrasion

Resulting from friction of the skin against a firm object causing removal of the epidermis (outermost layer of skin).

Define laceration

A wound or irregular tear to the flesh.

Define incision

A clean cut into the tissue.

Define excision

An area from which something has been cut out

Define excise

To remove by cutting.

Define mastic compound

Putty-like substance; absorbent sealing adhesive that can be injected under the skin or applied to the surface tissues to establish skin contour. (stuff dwyer loves)

Describe abrasions

Vary in size and depth

• Small and shallow, as from a fall

• Deeper and extensive, as from dragging during a car crash, and may also contain lacerations within the abrasion. (ex. road rash)

How does the length of the time between abrasion and death affect abrasions?

It affects:

• The amount of dehydration

• The color of the abrasion

• The amount of scabbing

How should non-viewable abrasions be treated?

• Embalm

• Seal abrasion with a sealer

• Cover with cotton

• Determine if plastic wrap or plastic garments is necessary

  • Abrasions are typically very dry wounds

How should viewable abrasions be treated?

• Before embalming, cover area surrounding abrasion with massage cream (but not to the abrasion itself)

• Embalm

• Remove scabs after embalming

• Dry the area using a cauterizing agent

• Seal with a liquid sealer

• Add wax, recreating pores and facial markings

• Cosmetize – Abrasions are often very dark and may need cosmetic treatment prior to applying wax.

Describe lacerations

• Vary in length, depth, width and tissue damage

• Typically caused by blunt-force trauma

Describe incisions

• Vary in length and width

• Typically caused by a sharp object such as a scalpel blade or a piece of glass or sharp metal.

How should lacerations and incisions below the skins surface be treated?

Treatment may include drying, packing, suturing and sealing the wounds.

• Prior to embalming determine if bridge sutures are necessary

How should lacerations near the skins surface be sutured in visible areas?

Worm suture

How should incisions near the skins surface be sutured in visible areas?

Intradermal suture

How should lacerations and incisions be treated in viewable areas?

• Dry inside of wound with cauterant

• Add massage cream to surrounding areas

• Bridge stitch where necessary

• Embalm

• Dry wound, re-treat with cauterant pack if necessary and add sealer internally to deep tissues.

• Pack with drying/incision powders

• Excise dried and dehydrated edges of wound

• Suture appropriately

• Wax, if needed, recreating pores and facial markings

• Cosmetize as needed

What are penetrating wounds?

Wounds entering the interior of an organ or cavity.

Give some examples of penetrating wounds

• Bullet entry or exit

• Medical devices (feeding tubes)

• Punctures

• Stab wounds

Describe penetrating wounds

Can vary in size from very small to very large, requiring minimal restoration to large cavity restorations

What is a puncture?

a hole from a piercing injury.

How should punctures be treated pre-embalming?

• Remove scabs using a sharp instrument

• Cover the area with an emollient

How should punctures be treated post-embalming?

• Excise dehydrated margins

• Ensure firm, dry tissue

• Close the opening appropriately (Is it viewable?)

  • Trocar button, Purse-string suture, or simply a dot of glue

• Wax if necessary

• Cosmetize if necessary

A rifle is a _____ velocity weapon

high

What creates faster moving bullets?

Longer barrels

A pistol is _______ velocity weapon

low(er)

Wounds from ______ range are typically more severe

close

What can bullets do inside the body?

Ricochet

• This damages the circulatory system and/or internal organs.

Describe entrance wounds

smaller, cleaner

What are some other injuries caused by pistol and rifle wounds not related to the hole itself?

• Swollen and/or discolored eyes

• Fractured bones

What should be done for pistol and rifle wound restoration pre-embalming?

• Face is covered with an emollient (lanolin spray/massage cream)

• Surface bleach ecchymosis around the eyes

• Cold compresses for swelling

What should be done for pistol and rifle wound restoration during embalming?

Leave wounds open and observe distribution

What should be done for pistol and rifle wound restoration post embalming?

• Excise dehydrated margins

• Ensure firm, dry tissue

• Large, deep wounds are treated as large cavity restorations

• Small wounds may be sutured

• Some wounds may need waxing, done over firm dry tissue.

• Treat remaining discolorations (such as powder burns and black eyes)

What three time periods can restorative treatments be divided into?

• Before Arterial Injection (Pre-embalming)

• During Arterial Injection

• After Arterial Injection (Post-embalming)

What time period is most restorative treatments done?

After arterial injection (post-embalming)

What is the first step in the pre-embalming period?

Clean the surface of the body

• Restorative analysis is best completed with a thorough cleaning of the body to expose any potential restorative issues.

• Clean orifices (including dentures, glass eyes, etc.)

• Remove surface stains

• Carefully remove debris (broken glass, leaves, grass etc)

• Remove any medical devices that may leaves marks or indentations

• Remove scabs or fever blisters

What is the second step in the pre-embalming period?

Set Features

• Shave everybody!

• Fill emaciated facial areas with cotton or putty

• Make sure eyes and lips are aligned properly and closed

What is the third step in the pre-embalming period?

Re-align

• Lacerated and cut tissue edges (tack sutures or glue)

• Simple and compound fractures, if possible

• Dislocated or twisted limbs

What is the fourth step in the pre-embalming process?

Treat Skin Issues

• Remove torn skin from desquamation

• Drain blisters, pustules and similar skin eruptions; remove loose skin

• Apply surface compresses to skin discolorations as necessary

• Excise tumors (with permission!) if they are causing features the be misaligned.

• Apply phenol or other cauterant to exposed skin areas to begin the drying process

What should be done during the active embalming period?

Establish good preservation!

• Few restorative or cosmetic treatments are done during embalming, but FIRM, DRY, WELL-PRESERVED TISSUES are the key to successful restoration!

• Choose fluids for your solution that are appropriate for the case you’re working on!

• Ensure distribution

• Control swelling

• Massage as needed

… ET CETERA…

What should be done at embalming completion?

Suturing

• Choose the appropriate suture for the given situation/location

Positioning

• Head and hands should be positioned appropriately

Massage cream

• Apply to face and hands to avoid dehydration

• “Floating” a piece of plastic onto the face can help preserve hydration

Cauterants

• Ensure phenol packs are clearing discolorations

• Ensure phenol applied to open skin areas is sufficient to dry the area

Then, LET THE BODY REST! This allows all your embalming treatments to set.

• Tissues firm

• Chemicals are given time to work

• Moist areas of tissue have time to dry

What should be done in the post-embalming period?

This is where most of your restorative work happens

• Tissue building

• Tissue reduction or excision

• Sealing of eyes and lips

• Sealing of sutured areas, as appropriate

• Reconstruction of features

• Application of wax, as necessary

• Cosmetic application to discolorations

• General cosmetic application

Define fracture

broken bone that is classified as simple or compound.

Define splint

An appliance of wood, metal or other suitable material used to protect or immobilize a moveable part.

Broken bones are classified as either:

Simple or Compound

What type of fracture is it where the broken bone does not pierce the skin?

Simple fracture

Describe the treatment for simple fractures

• Minor simple fractures require no restorative treatment

• Severe simple fractures may be require major restorative attempts including pre and post-embalming treatment, especially for head and face fractures.

What type of fracture is it where the broken bone has torn through the skin?

Compound fracture

Both simple and compound fractures can assume a variety of distortions

True

Describe an over-riding fracture

The bone margins overlap

Describe an depressed fracture

The bone margins are dented inward and the overlying surface area lacks support and normal surface contour/projection.

Describe multiple fractures

Two or more breaks have occurred in the same and/or different surrounding bones. “Crushed”

What is the best way to treat multiple fractures?

Best treated from inside the cranium and face via available orifices (oral, nasal, buccal, lacerations).

• If cranial autopsy was not performed and you must open the cranium, this is “major restoration,” and written permission needs to be obtained.

What is the general embalming treatment for broken bones?

• Remove packing materials and repack with clean, dry material

• Dry and seal incisions or breaks

• You may need to “hold” the bone with wire and/or replace missing sections with wood, plastic or metal pieces.

• Splints can be used as well on non-viewable areas to provide support to the fractured bone.

What is the restorative treatment for broken bones?

When normal appearance is distorted, post-embalming techniques include:

• Manipulate the broken bone until it comes back together. “Set” the bone.

• Build up sunken areas from within the cranial, buccal or nasal cavities using cotton, putty, etc.

How should you embalm severed limbs?

• Embalm the severed, or avulsed, limb separately using vessels if intact or hypodermically if no vessels are usable.

• Ligate and tie off vessels

• Dry and seal exposed tissue

• Suture the muscles of both parts tightly together, followed by the skin.

• Seal suture, cover with cotton once dry, and apply a second coat of sealer.

• Place in plastics.

Define avulsion

The tearing away or separation of a part of the body, resulting from an accident (or surgery).

How should missing limbs be handled if a limb is completed missing or partially missing restoratively?

• Use a dowel rod or splint to “replace” the entire or partial limb

• Insert rod into exposed area of the limb(s) and suture with a bridge suture to hold the dowel in place if possible.

• Cover with roll cotton and sealer.

• Tape with adhesive or duct tape, going 4-5 inches onto the skin to ensure proper replacement and secure hold of the prosthetic limb.

• Cover in plastics.

How should a missing hand be handled restoratively?

• A glove can be stuffed and attached to dowel or splint to represent a gloved hand.

• Pin the wrist end of the glove inside the sleeve to attach.

• Position the “arm and hand”

• A hand can be modeled with wax and placed under the natural hand. (Advise family or take other precautions!!!)

What is decapitation?

Separation (avulsion) of the head from the body

How should you embalm a decapitation?

• Inject the head and torso separately.

• For the head, the common carotids, if intact, are the best option.

• If missing, try the external and internal carotids or the external maxillary arteries.

• If no vessels are available hypo-inject and/or surface treat the head.

What is the restorative treatment for decapitation?

To securely rejoin, and properly align, the head and trunk:

• Obtain 3 dowels (wood, plastic, metal), about 8-12 inches in length, preferably with sharp/pointed ends.

• Insert 1 dowel into the spinal canal of the torso and then place the head upon the dowel, inserting it into the foramen magnum (achieve a proper “fit”).

• Insert remaining 2 rods into muscles on the lateral sides of the neck and secure dowels with wire and/or sutures.

• Suture muscle and deep tissue around entire circumference of the neck, filling missing tissue with mastic compound or cotton and sealer.

• Suture the skin together using an intradermal stitch if exposed or baseball stitch if unexposed.

• Seal, wax, add texture and cosmetize as needed if exposed.

• Seal, wrap securely with plastic and adhesive tape and/or bandage for additional support if unexposed (covered by clothing – the best/easiest option).

Define burn

To oxidize or be oxidized by fire or equivalent means, creating a tissue reaction or injury:

a. Heat or flame

b. Extreme cold (frost bite)

c. Caustics

d. Radiation

e. Friction

f. Electricity (lightning strike)

Define inflammation

Reaction to tissues to injurious agents; usually characterized by heat, redness, swelling and pain.

Define blister

Thin vesicle on the skin containing watery matter

Define singe

To burn superficially, as the hair, which shows partial destruction from scorching heat.

Define charred

Reduced to carbon; state of tissue destroyed by burning.

What are the characteristics of a first degree burn?

• Pink or red skin

• Unbroken skin

• No tissue destruction

• Possible odor; controllable

What are the techniques to treat a first degree burn?

• Typically present no unusual degree of difficulty

• May need a stronger than normal arterial injection solution

• Precaution against edema and/or skin slip

What are the characteristics of second degree burns?

• Acute inflammation with blistering or

• Complete absence of the epidermis

• Red tissue discoloration

• No charring and no major tissue destruction

• Hair may be singed

• Odor

What are the techniques to treat second degree burns?

• Open blisters and remove loose or excess skin

  • Recommended pre-embalming

• Apply surface pack with topical gel (cauterize and dry)

• Seal the area to prevent seepage

• Cosmetize

What are the characteristics of a third degree burn?

• Charring

• Destruction of surface and deep tissue (expanding/splitting)

• Muscle is not usually very affected

• Potential to be “non-viewable”

• Odor

What are the techniques to treat third degree burns?

Viewable Areas:

• Excise charred tissue

• Cauterize and dry excision tissue with surface pack

• Cover with sealer

• Suture with basket-weave, apply wax, create pore-effect and cosmetize

What are the characteristics of fourth degree burns?

• Charring

• Black, crumbling tissue

• Partially missing tissue

• Very discolored (black)

• Very dehydrated

• Complete incineration of tissue

• Muscle greatly affected

• Expansion and splitting of lesser charred areas

• Odor

Not appropriate for restoration attempts or viewing

What are the characteristics of singed hair?

• Shrunken

• Completely missing

  • Brows, lashes, facial hair, hair of head

What are the techniques to treat singed hair?

• Cosmetic, such as eyebrow pencil, eye shadow or mascara can be used to recolor singed areas.

• Completely missing hair must be replaced with hair replacement techniques (Ch. 10L).

Define excision

An area from which something has been cut out.

Define excise

To remove by cutting.

Define undercut

An angled cut of the borders of an excision, which is made so that the skin surface will overhang the deeper tissue.

How should you handle excisions that happened before death?

Treat the wound

How should you handle excisions after death?

• Know proper techniques for removal

• Know proper treatment requirements for the exposed deep tissue, following excision

when should you excise tissue pre-embalming?

Only when the tumor is blocking circulation

What are some things that may be necessary when performing an excision before embalming?

• Bridge sutures may be necessary to hold margins of the incision together

• Bridge suture may be necessary to support the margins of a large area of excised tissue

Excision is recommended ______ embalming

post

How should excision occur on the face and why?

Within the buccal cavity (unexposed) whenever possible so that leakage will occur within the mouth and drain into the throat.

Undercutting may prove beneficial as opposed to ______________ cuts

perpendicular

What are the uses of undercutting?

• To lock the wax under the edge of the wound

• To allow tapering of the wax over the edge of the wound

• To lower the level of ligature when performing a basket weave suture

Absorption

the process of taking in, as in a colored object which absorbs certain rays of light and reflects other rays giving the object its recognizable color. (e.g., An apple is called red if the red rays are reflected and the other rays of light are absorbed.)

Achromatic color

a color not found in the visible spectrum; a neutral color such as white, black, gray, and silver and gold (for decorative purposes)

Additive method

a process of mixing colored lights on a surface on which the wave lengths of each are combined; adding two or more colored light together to create another color of light.

After-image

psychological; a visual impression remaining after the stimulus has been removed

Analogous

in color harmony, two or more hues which have the same hue in common

Brilliance

brightness; in colored illumination, the quantity of illumination passing through a color transparency

Chroma (intensity)

brightness or dullness of a color

Chromatic color

a color having a hue; a color of the visible spectrum

Color

a visual sensation perceived by the eye and the mind due to the activity and vibration of light

Color rendering index (CRI)

a measurement of light quality of a light source as compared to sunlight

Colored filter

colored glass, gelatin, or other substances which transmit light of certain wavelengths which absorbing others

Colored light

illumination of an identifiable hue

Color wheel

a circle in which the primary, secondary, and intermediate hues are arranged in orderly intervals

Complements

directly opposite hues on the color wheel; and two pigmentary hues, which, by their mixture in equal quantities, produce gray