Clare Lamb

From formalin to thiel embalming: What changes? One anatomy department's experiences

In 2009, the Centre for Anatomy and Human Identification started Thiel embalming on a small scale to assess (i) the suitability for our current teaching in which long‐lasting dissection courses are key, (ii) the potential for new collaborations and activities, and (iii) the practical implications of changing our embalming method from formalin to Thiel. Twenty six Thiel‐embalmed cadavers have been used for dissection by staff and students on a taught MSc course, as a model for clinical and surgical training, and increasingly as a model for evaluation of new medical devices and procedures. Our experiences with dissection were mostly positive especially for teaching the musculoskeletal system. Internal organs handle differently from formalin‐fixed organs and dissection manuals need to be adjusted to reflect this. Durability of the cadavers was not an issue, though changes are seen over time due to gradual fluid loss. We have started new collaborations related to postgraduate anatomy teaching and advanced training in surgical and clinical skills. In general, feedback is very positive and demand for cadavers outstrips our current limited supply. Thiel‐embalmed cadavers were found to provide a unique opportunity for evaluation of medical products especially in areas where no suitable alternative model is available, and without the complications associated with clinical testing. This has resulted in new collaborations and research projects. As a result Thiel‐embalmed cadavers are used for longer and for more activities than formalin cadavers: this requires changes in our procedures and staff roles. Clin. Anat. 26:564–571, 2013.

A pilot study comparing the use of Thiel‐ and formalin‐embalmed cadavers in the teaching of human anatomy

Formalin had traditionally been used to preserve human material to teach gross anatomy. In 2008 the Centre for Anatomy and Human Identification (CAHID) at the University of Dundee embarked on the use of the Thiel method of embalming. The aim of this pilot study was to assess the difference between formalin‐embalmed cadavers (FEC) and Thiel‐embalmed cadavers (TEC) used for teaching and surgical training. Three different questionnaires were prepared for data collection from undergraduate and postgraduate students and clinical staff. All undergraduate and postgraduate students as well as clinical staff commented on the appearance of the TEC. There was no overall consensus concerning the use of TEC, some respondents preferred TEC for the entire dissection, some only for certain areas such as the musculoskeletal system. On a technical level TEC were considered less hazardous then FEC by one‐third of participants with fewer than 10% regarding TEC as more irritating than FEC. Psychologically, 32.7% of undergraduate students expressed the view that TEC made them feel more uncomfortable compared with FEC because of their life‐like appearance. However, 57.1% of undergraduate students encountered the same uncomfortable feelings when viewing both TEC and FEC. The use of Thiel‐embalmed cadavers to teach anatomy has an added value, though further research is required over longer periods of time to identify its best usage. Anat Sci Educ 8: 86–91.

The sensory distribution in the dorsum of the hand: anatomical study with clinical implications

The sensory distribution in the dorsum of the hand was investigated in 150 formalin-fixed hands with the aim of outlining the most common innervation pattern of the superficial branch of the radial nerve (SBRN), dorsal branch of the ulnar nerve (DBUN) and the lateral antebrachial cutaneous nerve (LABCN). Although variable, the most common pattern found was SBRN innervation to the dorsal surface of the lateral 2½ digits and DBUN innervation to the dorsal surface of the medial 2½ digits. Dual innervation due to communicating branches or nerves overlapping was found in 41 cases. All-radial supply to the dorsum of the hand was found in ten cases. The LABCN was closely associated, and occasionally overlapped, with the SBRN. There were significant differences in the sensory distribution of the dorsum of the right and left hands of the same cadaver. The sensory distribution in the dorsum of the hand is variable; however, understanding the most common innervation pattern and appreciating the possible variations to this pattern is important to avoid errors in interpretation of conduction velocity studies, misdiagnosis of nerve pathology signs and symptoms and inappropriate treatments.

An anatomical study of the superficial palmar communicating branch between the median and ulnar nerves.

The palmar communicating branch between the median and ulnar nerves was investigated in 98 hands with the aim of outlining its most common branching patterns and describing its relationship to well-defined anatomical landmarks, including the bistyloid line, wrist crease and flexor retinaculum. Five branching patterns were identified and classified based on their proximal and distal attachments. The palmar communicating branch was found to lie between 26%–79% of the total distance between the metacarpophalangeal joint of the long finger and the wrist crease, and 35%–75% of the total distance between the metacarpophalangeal joint of the long finger and the middle of the bistyloid line. With the aid of the morphometric indices obtained from this study, a risk area where the palmar communicating branch is most likely to be found is outlined. Knowledge of the branching patterns and location of the palmar communicating branch can help clinicians to better assess variations in the patterns of sensation, preserve the nerve during surgical interventions to the palm and better assess post-operative complications involving the branch.

Ulnar nerve cutaneous distribution in the palm: Application to surgery of the hand

The ulnar nerve (UN) was classically described as supplying most of the intrinsic muscles of the hand, and the cutaneous innervation of the ulnar one and half digits, by dividing into superficial sensory and deep motor branches in Guyons canal. Variations of this pattern have been reported in the literature. This study investigated the cutaneous distribution of the UN in the palm following the dissection of 144 cadaveric hands. The UN was examined and the distances from branching points of the superficial branch to the proximal edge of the pisiform were measured. The UN bifurcated (80.4%) into one deep trunk and one superficial trunk, which further divided distally into the proper digital (PDN) and common digital (CDN) nerves or trifurcated (19.6%) into one deep trunk, a PDN and a CDN in Guyons canal. It received fibers from the median nerve in four cases and from the dorsal branch of the UN in six cases. A classification scheme based on the nerves contributing to the sensory innervation of the ulnar side of the palm was suggested. Understanding the cutaneous distribution of the UN in the palm and appreciating possible communicating branches can help clinicians to assess hand pathologies better and avoid injuries during surgical interventions. Clin. Anat. 28:1022–1028, 2015.

Thiel embalming fluid—A new way to revive formalin-fixed cadaveric specimens

By soft fixing cadavers using the Thiel embalming method, our cadavers now exhibit a greater degree of flexibility and color retention compared to that of traditional formalin‐fixed cadavers. The aim of this experiment was to discover whether Thiel embalming fluid could be used to revive and soften the muscles of formalin‐fixed prosected specimens. Earlier this year, two severely dehydrated formalin‐fixed forearm and hand specimens were fully submerged in a tank containing Thiel embalming fluid. After a period of six months the specimens were removed from the tank and noticeable changes were observed in flexibility, quality of the tissue, and color of the specimens. Clin. Anat. 27:853–855, 2014.