Updated: Jun 20
When faced with a body that will require post-mortem reconstructive surgery to repair massive head trauma, the first thing that must be considered (besides having an embalming and restoration authorization signed by the next of kin) is proper embalming. You cannot reconstruct a poorly embalmed body. The tissues must be firm, dry, and well preserved.
The damage done by the trauma can often make this a difficult task. During your pre-embalming analysis, I recommend keeping detailed notes on the areas damaged. Note bone and soft tissue damage. As you progress with your analysis, try to see beyond the overall graphic nature of the case and view damaged areas individually. Begin by cleaning the body thoroughly with a quality disinfectant soap. Treat the eyes, ears, nose, mouth, anal, and, if female, vaginal cavities with a broad-spectrum disinfectant. Once the body is disinfected and cleaned of blood and any debris that may be present, you may begin to devise a plan to embalm and repair each area of damage.
In general, I have found in my own practice, that a restricted cervical injection using a waterless embalming solution offers the best chance for success. Always embalm the traumatized head first. While I do not endorse or work for any chemical company, I have found through the years that my preferred mixture for waterless embalming of the traumatized head is two bottles each of Dodge Rectifiant, Metaflow or their new Pro Flow, and Introfiant. I may add a half ounce to an ounce of Dodge Icterine regular dye to the mixture. This mixture has given me consistently good results.
Start by injecting the left side of the head and then the right. I prefer to always inject at 140 psi of pressure and 5 – 7 opm flow rate. Keep in mind that too high a rate of flow, not high pressure, is what causes swelling. Due to the nature of the trauma, you may find that the vascular system has been interrupted to the point that certain areas do not receive adequate, or any, fluid. In this case it will be necessary to thoroughly hypo the areas in question. I will use the same mixture mentioned above and a syringe with a quite small needle. You must inject fluid about every quarter of an inch in a grid pattern and massage the fluid into the tissue as you go. Continue this procedure until all questionable areas are thoroughly injected.
Once the head has been completely and adequately preserved; the tissue is firm and dry, continue to embalm the rest of the body with a stronger than normal solution of your choice. I recommend a 3% solution as a starting point and increasing strength in subsequent gallons as needed, all the way up to waterless. Use 140 psi pressure and 12 – 15 opm flow.
For cavity treatment, aspirate thoroughly. Get as much liquid from the cavities as possible. Then, using a very sharp trocar, very thoroughly puncture all internal organs with multiple thrusts. This is particularly important in the large and small intestines and other hollow organs. The cavity fluid must have access points to the lumen and direct contact with the tissue. Gas phase embalming, as it was once known, has been proven to be ineffective. My preference for cavity fluid is Hydrol Super 50. It does not contain any water and is highly effective. Use at least one bottle in the thoracic and one bottle in the abdominal cavity. Always carefully and thoroughly re-aspirate the next day and re-inject more cavity fluid if needed.
Once the injections are complete, wash the body with disinfectant soap and prepare to begin your reconstruction work. Following these simple steps will ensure the best chance for success by creating a well preserved and thoroughly disinfected body.