ET2 Long Bone Donor

Tissue Donors: Long Bones

Long Bone donation can include removal of: Leg: Femur, Tibia, Fibula, Hemipelvis; Arm: Proximal Humerus, Scapular (en bloc);

Real Complications/Considerations of Long Bone Tissue Donors

Very time consuming; Requires the use of a lot of fluid and material; Use strong fluid due to delay in preparation

Three

________ methods in the book are explained for LONG BONE TISSUE DONATION; The book also advocates the use of the FEMORAL, POPLITEAL, AND ANTERIOR TIBIAL ARTERY as injection sites and that they are ligated and ready to go (if they are present and in-tact) ARTERIAL INJECTION

Open/Internal Approach (LONG BONE)

Remove sutures and prosthesis. Locate arteries mentioned earlier and inject; Trunk, head, and arms may be injected by cervical or femoral (iliacs) sites; Hypodermic treatment of muscle tissue is probably necessary; Cauterize tissue (in leg area) with a phenolic spray such as dryene or phenox; Complete other supplemental or accessory techniques as needed for adequate preservation; Final steps- replace prosthesis and suture in place; Add absorbent cotton, preservative powder etc. Suture closed

Free Flow Method (LONG BONE)

Leave sutures in place and inject the legs via the iliacs (or femorals); Use = parts water with a strong arterial fluid, or use a waterless solution. Inject at least ½ gallon in each leg; Let this sit and osmotically embalm the legs while the rest of the body is embalmed; after embalming is complete, small holes are made around the ankles to relieve any fluid; surface glue is applied to sutures and cotton; stockings can then be placed on the legs with absorbent powders added; to close small holes, use TROCAR BUTTON or a PURSE STRING SUTURE

Whip stitch

alternative suture that is quick

cotton

put __________ on the ends of prosthetics

Tack stitch

An RA suture for GAPING AREAS; also called a BRIDGE STITCH, INTERUPPTED STITCH, AND TEMPORARY STITCH; used to get shape of leg back or if injury to face; usually removed after embalming; GETS BACK RIGIDITY

Combination of Open/Internal Approach and Free Flow Method

Locate both iliac arteries and clamp off; the sutures will need to be opened enough to raise the iliacs; the iliac arteries can be injected (inject one iliac towards the heart and assess the results; both arteries should be injected down to embalm the legs) USED FOR A DRYER END RESULT

Saturated Packing Method

Saturated and absorbent packing is placed inside the open incisions of the procurement site and then sutured; clean sheets/mortuary cotton (saturate with care/do not over saturate); hypo inject, paraformaldehydes and powders, baseball suture

Proximal Humerus

No reason why arterial supply need to be disrupted; it may be possible to inject without opening the incisions if they are tight (probably should, to add hardening compounds and preservative powder);if vessels are cut the brachials, radials, and ulnars can be injected; good idea to inject both ways- away and towards the heart is as many vessels as possible to ensure preservation; hemostats can be used to clamp off leaks

For Viewing purposes

Why are only typically the upper arm bones taken only?

Organ donation

utilize your knowledge of autopsy and partial autopsy embalming and closure techniques for embalming

Mandible

not recovered often; can be recovered in bodies that will not be viewed; two methods of recovery used, both have significant embalming and RA consequences

Ribs

Same incision as vascular organ recovery; every other rib is removed; intercostal arteries can be disrupted; stop leakage if this is the case; significant changes aren't otherwise required

Middle Ear or Temporal Bone

DON'T TAKE ANYMORE

Middle Ear/Temporal Bone Internal Approach

BEST APPROACH; done after embalming usually; may be done during or after autopsy; plug cutter is used; if done prior to embalming it shouldn't pose any circulatory problems for the embalmer; MORE INVASIVE BUT DOESN'T AFFECT THE VASCULAR SYSTEM

Middle Ear/Temporal Bone External Approach

Eyes and upper face don't receive adequate amounts of fluid; incision behind ear is made; read up on the procedure

In Conlcusion

We aren't just taking care of the deceased via the technical aspects (art+science) of embalming; an embalmer is also caring for the surviving and grieving family members through their embalming care of that family's loved one; remember, it can be a very difficult and personal decision for an individual or family to chose to donate organs or tissue, whether their answer is yes or no, honor that, treat them with the utmost respect, always; for donors they and/or their family have chosen to enhance and/or save lives (very honorable); donor remains are extra work, time and materials for their emblmer; you are playing your own small part in that life saving/life enhancing process; change your mindset from one of frustration and imposition to one of gratitude and honor, and then the extra work and time won't seem so hard; we are the expert after all