Tissue Damage (Q3)

Question 1

Types of Tissue Damage

Answer 1

Stains on the skin
Intravascular Discolorations
Extravascular Discolorations
Trauma
Pathology (disease)

Question 2

Stain

Answer 2

• Surface stain and debris (tissue is soiled)
• Physically remove the stain, but be careful not to damage tissue further.

Question 3

How can you remove blood from the skin?

Answer 3

Hydrogen peroxide

Question 4

How can you remove nicotine from the skin?

Answer 4

Lemon juice

Question 5

How to remove other stains on the skin?

Answer 5

Try dry shampoo

Question 6

Intravascular Discolorations

Answer 6

• Staining of the tissue which lies within the vascular system
• Because the stain is still within the capillaries it is possible to flush this stain out
• proper arterial injection can “flush” out the discoloration

Question 7

Extravascular Discolorations

Answer 7

• Staining of the tissue which lie outside the vascular system.
• Because the staining has escaped the capillaries and moved into the surrounding tissue, it is not possible to “flush” it out.
• Hypodermic injection of phenol, external phenol compress; after bleaching, use cosmetic

Question 8

Types of trauma the embalmer may encounter

Answer 8

Abrasions
Gashes
Incision
Lacerations
Burns
Fractures
Gunshot wounds
Sharp force (stabbing)
Dismemberment
Decapitation
Hanging

Question 9

Abrasions

Answer 9

• Caused by friction
  Ex: skinned knee, road rash
• Problems: dehydration
• Solution: preserve with compress, or excise tissue first, then preserve with compress.

Question 10

Gashes

Answer 10

• Long deep tears in tissue
• Caused by blunt force trauma or pulling apart of tissue.
• Suture the opening partly closed so tissue does not firm up in open position.
• Preservative compress may be needed if arterial injection was not sufficient (this is applicable to all types of trauma)

Question 11

Incisions

Answer 11

• A purposeful, clean cut in the tissue. Usually from medical treatment.
• If there is suture or staples present, remove them.
• Treat inside of incision with preservative compress.
• Re-suture incision closed after raw tissue has be cauterized.

Question 12

Lacerations

Answer 12

• Incidental cut of the tissue.
  Ex: cut from glass in auto accident
• Treatment is same as incisions.

Question 13

Types Burns

Answer 13

• First degree burns: most superficial, epidermis only
• Second degree burns: burn has gone deeper in to the dermis (second layer of skin)
• Third degree burns -> “full-thickness burn”
• Fourth, fifth, sixth degree burns: tissue and underlying muscles and bone are charred.

Question 14

Burns

Answer 14

• excise any dehydrated tissue and clear the margins
  of the opening.
• Cauterize the open tissue.
• Apply a basket weave stitch if necessary.
• Fill with wound filler and cover with wax and cosmetics.

Question 15

Types of Fractures

Answer 15

• Simples fractures: skin has not been broken, but deformity may be present
• Compound fractures: skin has been broken, deformity will be present
• Comminuted Fracture: skin is not broken, but they’re multiple small broken bones inside (can be simple or compound)

Question 16

Fractures

Answer 16

• Attempt to realign the fracture bones so the position of any limbs looks natural.
• Splints, blocks and other devices may be employed to achieve the correct alignment.
• If the skin is broken, treat with phenol to cauterize tissue.

Question 17

Types of Gunshot Wounds

Answer 17

• Grazing: abrasion on surface
• Lacerating : tears surface open, but does not puncture (a cut)
• Penetrating: bullet enters and does not exit (entry wound only)
• Perforating: bullet enters and exits (entry and exit wounds)

Question 18

Difference between entry wound and exit wound

Answer 18

• Entry wound: wound where the bullet enters.
• Exit wound: where the bullet exits (there is not always an exit wound)

Question 19

Types of Stab Wounds

Answer 19

• Stab wounds: deeper and it is long (ex. knife)
• Chop wounds: can be long/wide with extensive damage underneath (ex.machete, cleaver)
• Impaling wounds: similar to stab wound but much deeper, may be an exit wound (ex. rebar, metal fence post)

Question 20

Dismemberment

Answer 20

• Separation of a limb from trunk of body
  (if amputation was a past surgery and the person lived with the amputation, consult family about limb restoration and presentation)
• Severed limb occurred at time of death, reattach limb.
• If the limb is missing (not found at accident site), re-create limb by filling clothes, gloves with stuffing, wood dowels, wires as needed.
• Use wiring in glove to mimic arch of fingers.

Question 21

Decapitation

Answer 21

• The head is severed from the trunk of body
• Use wooden dowels to create support.
• Suture head back onto neck.
  cover with wax and cosmetics as needed.

Question 22

Hanging and physical asphyxiation

Answer 22

• Hanging causes dehydrated ligature marks high on the neck, near the jaw line.
• Other physical asphyxiation (not hanging) may cause the ligature marks to be in a lower location on the neck.
• If thin ligature was used, or enough pressure was applied, there may be lacerations on neck.
• Eyes may be swollen. Use pressure compresses and channeling, if necessary.
• Dress in a high-collared shirt, or employ a scarf.

Question 23

Acne

Answer 23

• If pimples are large, drain and reduce swelling.
• Lip wax may be needed to
  fill open pore before cosmetizing.
• If pimples are small, do not drain them. cosmetize over them.
• If scarring from chronic acne is present, consult family about
  presentation options.
• Be sure the skin is clean and dry before cosmetizing

Question 24

Decubitus Ulcers/Bed Sores/Pressure Ulcers

Answer 24

• Long-term pressure on a specific area of tissue causes lack of blood flow to area and causes tissue to become inflamed, and in severe cases, become infected and rupture.
• more likely to occur on the posterior of the body and not usually an RA concern.
• The ulcers need to be addressed during embalming because they may have an odor

Question 25

Psoriasis

Answer 25

• Plaque psoriasis: red bumps on epidermis at the arms, elbows and scalp
• Clean off dry flakes of skin.
• Pustular psoriasis - pustules are present, esp. soles of feet and palms of hands.
• Drain pustules and treat with topical embalming gel.

Question 26

Seborrheic Dermatitis

Answer 26

• Disorder of the sebaceous (oil producing) glands of the skin.
• Effects range from light dandruff to thick crust on skin, depending on severity.
• Soaking affected area with humectant (or ½ humectant, ½ surfactant) (moisture retention compress) to loosen skin flakes and wash away.

Question 27

Sebaceous Cysts

Answer 27

• Growth under the skin containing keratin and lipids.
• Excision of cysts may be necessary. Treat topically with autopsy gel.
• Consult with family before removing the cyst.

Question 28

Tumors/Cancers

Answer 28

• Broad category of “neoplasms,” or growths in and on the body.
• Benign tumors - growth that does not spread through the body
• Malignant tumor - cancerous growths that can spread throughout the body
• Consult the family about excising the growth.
• Treat with a topical autopsy gel. Wax and cosmetize

Question 29

Tips for All Tissue Damage

Answer 29

• Be sure the affected area is thoroughly embalmed
• Before restorative treatments (wax and cosmetics), be sure that the area is firm, clean, and dry