My Ever Evolving Embalming Tenets
Updated: Aug 19
ADVANCED EMBALMING TECHNIQUES
In my travels speaking to various funeral trade groups and mortuary science students, I am struck by the lack of knowledge regarding various embalming strategies and techniques. It is amazing to me that many practitioners never learned basic skills such as hypo work, proper case analysis, intermittent drainage techniques, etc. This blog, though a bit long, will address all this and much more. It will be light on theory and focus mainly on techniques that are proven to work; even on the most difficult cases.
So, lets dive right in and get started with my ever-evolving list of embalming tenets.
· A thorough case analysis is paramount for good results. There are no shortcuts. Take the time to study the body carefully, noting any problem areas and/or situations. Note them on your embalming report form. Try to learn the cause of death when possible. This can be of great help when formulating your embalming plan. Finally, with all your information and observations in mind, take a cue from Vernie Fountain and “Think it Through.” Decide on your products and procedures to rectify any situations and proceed slowly and deliberately; altering your actions as the case dictates.
High pressure/ low flow embalming has been proven to be superior (see my article in the Spring 2020 Dodge Magazine). High pressure (140 psi has proven to be a “sweet spot”) will not cause swelling. Too high a rate of flow is the cause of swelling. You may need to upgrade your embalming machine to achieve these targets. On a “normal adult body, the rate of flow can usually be safely in the 12 -15 ounces per minute range when injecting downward into the body. When injecting the head, 5 – 7 ounces per minute is generally acceptable. On infants, a lower rate of flow will be needed but leave the pressure at 140 psi. Remember, each case is different. Watch closely and adjust flow as needed.
· Always use warm water (around 100 ̊is a good rule of thumb) in your fluid mixtures. This lowers surface tension and aids in superior distribution and drainage.
DO NOT add water to the fluid mixture when embalming infants. The infant body already contains about 80% water.
· DO NOT add water to your mixture for edematous bodies. Like infants, there is no need to add more water to a situation where too much water already exits. Doing so will only exacerbate the problem and end in a very poorly preserved, waterlogged body. Sectional embalming is often required in edema cases.
· Know your chemicals and keep a good stock of various supplies on hand to address any case you may be called upon to embalm. The days of “pre-mixing” your “standard” solution for “normal bodies” and low index mixtures are a thing of the past. With the drug therapies and other life extending treatments being used in the medical world, we are increasingly seeing bodies with multiple problems that can interfere with embalming. I suggest a minimum dilution of 3% (Index x Ounces of Fluid / Water added) as a baseline on “normal” cases and go up in formaldehyde concentration from there, as the case requires.
· Avoid using dry cotton in the mouth. Saturate it with Dodge Restorative first to keep it from acting as a wick and pulling moisture from the mouth and lips.
.The only place those oval eye caps belong in the prep room is in the garbage can. Use the round perfection type. The oval caps cause an odd look and I can spot them in a second. The ball of the eye is not oval. Also, don't use too large of an eye cap.
· Avoid using petroleum-based products (Vaseline), massage cream, or Silicone based products (Texture Cream) on the lips or face. They are difficult to fully remove and can cause problems with cosmetics. A better solution is Dodge Restorative in a spray bottle. Spray the face and cover lightly with plastic wrap. This will prevent dehydration and will not cause problems. No real clean off is needed before cosmetics other than making sure the face and hands are dry by blotting off any excess. For longer term holding or refrigerated bodies, spray the face and hands with Restorative, then cover with Webril and saturate the Webril with the Restorative. Cover lightly with plastic wrap.
· For a good, natural color, start from the inside out. Good quality fluid dyes are a must to achieve a nice skin tone. Note that the colors of the fluid itself, unless specifically stated as such by the manufacturer, are not generally staining dyes. They are merely used to distinguish one fluid from another. You must add the staining dye to your mixture. A good rule of thumb is 1 – 2 ounces added per gallon of fluid. Dyes vary in intensity, so the embalmer needs to be familiar with the particulars of the dye he/she chooses to use. I find that most dyes will come on fairly strong, allowing for good tracing, at first but will fade somewhat in the days that follow injection. Keep this in mind when adding dyes.
· Don’t be afraid to use strong fluids on difficult cases. Todays modern fluids are buffered so the old idea of “fluid burn” is a thing of the past. Brown patches on embalmed skin are actually the result of dehydration from not using a strong enough fluid. Well embalmed tissue will not dehydrate like poorly embalmed tissue.
A humectant, like Dodge Restorative, should be added to your embalming mixture for all slender normal to emaciated cases. Use at least 8 ounces per gallon of fluid. On bodies to be held for long periods of time, use 12 to 16 ounces per gallon of fluid.
· Always use intermittent restricted drainage. This will help overcome anastomoses and force fluid into areas that may not receive adequate fluid otherwise. It can also help to add bulk to an emaciated face, when used with a humectant like Dodge Restorative.
· Trocar tips must be kept sharp in order to penetrate hollow organs. Use a file to sharpen tips when needed.
· Delayed aspiration can be beneficial by keeping the vascular system under pressure for a period of time, allowing the fluid to continue to penetrate; generally, from one to twenty four hours, depending on the case.
· A minimum of two bottles of cavity fluid is necessary in adult cases. Inject one into the thoracic and one into the abdominal cavities. On very large bodies, inject a third bottle in the middle abdomen.
Treat all cases of drowning, recent abdominal surgeries, or abdominal injuries as tissue gas cases. These cases are the most likely to develop tissue gas even if it is not immediately noticeable. Use a strong to waterless injection. It takes an 8% formaldehyde solution to kill clostridium perfringens. A surer answer is to add one bottle of Dodge Halt or Dodge Dis-Spray per gallon of strong fluid. Treat the cavity with Halt Cavity Fluid or Basic Dryene instead of cavity fluid. Inject 30 cc of Basic Dryene into the brain through each nostril, penetrating the cribriform plate of the ethmoid bone.
· It is not uncommon for embalmers to mistake subcutaneous emphysema for tissue gas. Both present in a similar manner, but true tissue gas caused by clostridium perfringens has a unique foul odor and spreads quickly. A body can embalm normally and look good, two or three hours later it is a mess. As I mentioned above, treat all drowning or abdominal injury or surgery cases as tissue gas cases. Subcutaneous emphysema is generally seen in cases of lung injury. Broken ribs, chest tubes, etc. can be a sign that you are dealing with subcutaneous emphysema. Channel and force trapped air under the skin out as much as possible BEFORE embalming. It will be very difficult, if not impossible to remove once the tissues are set with embalming fluid.
.Pierce Triton 28 is a favorite fluid of mine on jaundice (as well as most any normal case). It is often helpful to use color cancelation when injecting. Use a strong fluid and add a good bit of extra red dye, like Dodge Icterine Regular, to the mixture. The red will help cancel out the yellow/green shades. Some people find a pre-injection of equal parts Dodge Metaflow or Proflow and Rectifiant along with Icterine Regular Dye and warm water to make one gallon of pre-injection fluid, injected against closed drainage and allowed to remain for fifteen minutes or so (look at the palms of the hands to see if you are getting color change) to be helpful in jaundice cases. If this works for you then by all means do it. My only caution is that edema often accompanies jaundice. NEVER pre-inject a case where edema is present. Also, the jaundice color will not be “washed away” by pre-injecting or the old method of using large amounts of low index fluids. The coloration is mainly inside the cellular complex and cannot simply be “flushed” away. Using milk is a sure ticket to court. This old wives tale has been around forever. There is absolutely NO basis in chemistry why this would work and is not considered a "normally accepted professional practice."
· I have found that “spiking” your formaldehyde fluid mixture with about 6 ounces per gallon of glutaraldehyde, like Champion Di-San, can be very beneficial for overall tissue fixation and appearance. It is also a very powerful germicide.
· Hypo treatment is required on all areas that will not receive adequate penetration and preservation from arterial embalming. I am amazed at the number of embalmers I have met who were never taught about hypo work. It is an important skill and must be a “tool” in your kit. A hypo valve trocar is useful for larger areas and for hypoing flaps, shoulders, buttocks, etc. in autopsy work. A 25 cc or so syringe with a 20 gauge needle is a good all-around hypo tool. I like to use the same syringe with very small, basically insulin size needle, for facial work.
· Fingertips that don’t receive adequate fluid and “prune” can be hypo injected with Dodge Firming Tissue Builder. This will not only fill out the area but will also preserve.
· Placing a hemostat on the upper section of the carotid artery after about 5 minutes of injecting down will allow the entire head to receive fluid about 98% of the time. No need to inject up into the head.
· Don’t overuse powdered incision sealer in the carotid incision. It will swell and create an unnatural “lump” on the area. Place a bit in the incision and push it around with your index finger to insure light, even coverage of the void.
· Closing the carotid incision with an inversion (worm) suture and filling the void with Dodge Perma Seel glue before pulling the ends tight will create a leak-proof, nearly unnoticeable suture.
Most decomp cases, if not advanced to the point where the flesh is totally destroyed, can be embalmed and restored to a viewable condition. Maggots can be eliminated with acetone or Dri Wash. It may require several applications to kill them all. Treat the eyes, mouth, nose and ears liberally with Dis-Spray. Wash the body thoroughly with antibacterial soap and scrub or peel off any areas of skin slip. Coat the entire body generously, front, back, and entire head and face, with a 50/50 mixture of Dodge Syn Gel HV and Basic Dryene (Jack Adams’ Super Gel). Inject the head first with a waterless mixture of 2 bottles of Dodge Introfiant, Rectifiant and Metaflow along with one bottle of Champion Di San and Omega Decomp Factor. Use a restricted cervical injection. Inject the left side first and then the right. Additional hypo work will be very likely. Inject the rest of the body using the same mixture. Use as much as it takes to get full penetration and distribution. NO WATER! Multi point injection and hypo work will very likely be needed. Inject 25 cc Basic Dryene through the cribriform plate inside each nostril into each side of the brain (50 cc total). Pack the nose with webril. Thoroughly aspirate the body cavities and inject two to three bottles of Basic Dryene instead of cavity fluid. Give the body another coat of the “Super-Gel” mixture and cover with plastic. Allow to remain for 24 hours. After 24 hours wash the body thoroughly again to remove the gel and any additional skin slip. Check carefully for any areas that may need additional hypo work. Re-aspirate and inject two to three bottles of strong cavity fluid. I prefer Hydrol Super 50. Dry the body thoroughly. A hairdryer is useful in drying the tissue of the face and hands. I prefer to wrap the body, excluding the face and hands, of course, with plastic, securing it in place with 3M Super 77 spray glue. The body may then be placed in a unionall, if desired. Add copious amounts of Dodge-Sorb and some Action Powder in the plastics if desired. Glue the mouth and eyes. Pack the nose and ears with webril. Push it as far as possible into the openings. If it can still be seen slightly, it can be colored with dark cosmetic later. Seal the webril by saturating with super glue and spraying with Tech Bond Activator to instantly set. Fill any voids in the facial skin with a thin coats of NecroDerm Wax Replacer and smooth and texture to re-create missing skin, if necessary.
Cosmetics will require a sealing base such as NecroMetics® NecroPAX™ on the face and hands to seal and obliterate discoloration. Choose and mix the NecroPAX™ shades and adjusters to try and get the closest possible match to the base skintone. Apply in multiple light layers, allowing to dry between coats. A hairdryer set on the COOL setting can speed drying. After the NecroPAX™ is completely dry, spray with Green Marble Sealer and dry with a hairdryer. An airbrush with the Skin Illustrator Airbrush Liquids can be used to fine tune the foundation and blend in areas like the hairline, eyebrow area, etc. Finish the pointillism and color adjustments in the various areas of the face with the Skin Illustrator palette by “splattering” a very dilute wash of color with a splatter brush or a trimmed chip brush. Use multiple layers of the color “washes” until a realistic skin tone is achieved. Finish with a light application of Zer0Color Powder. Repeat the cosmetic procedure for the hands. Following these steps can give you a well preserved, odor free, viewable body.
That's all for today's blog. Check back often for much more to come. And remember you can always reach me at firstname.lastname@example.org