This article (ET-21) is a continuation of the autopsy and autopsy procedures.
    During the autopsy the organs may be removed one at a time, in blocks or in mass. This is at the discretion of the pathologist. Embalmers who do autopsies usually remove the organs of the body in mass. In cases where time is limited, mass removal of the trunk organs and cranial contents is done before dissecting sections for examination. The body may then be released to a funeral home or the embalmer without delay.
    Licensed embalmers or practitioners may be very proficient and competent at mass removal of the body organs. There are cases where this must be done by the embalmer prior to the embalming procedure. The sequence of removal is as follows:

• A primary Y incision is made and the intact organs are examined in situ.
• The three major arteries in the arch of the aorta are litigated and cut.
• Transect the trachea and esophagus just below the larynx or transect and remove the tongue, larynx, pharynx, thyroid and parathyroid glands.
• Litigate all visible branches of the carotids.
• Separate the organs from the vertebral column.
• Separate the thoracic organs from the thoracic spine.
• Separate the abdominal organs from the lumbar vertebral region, litigating the common iliac arteries.
• Separate the bladder and prostate or the vagina and uterus.
• Tie off the rectum with a double ligature.
• Separate the diaphragm cavity walls.
• Gently remove the total mass (15 to 25 pounds) for pathologist examination.

SEQUENCE OF GENERAL PATHOLOGICAL AUTOPSY

• Examine overall body externally and list observations
• Make a Y incision on the chest, retract the skin, and separate the rib cartilages and sternoclavicular joints.
• Examine thoracic and abdominal cavities and take samples of the fluids.
• Remove the organs in the following sequence: Cranial organs (brain and pituitary gland), Neck organs (bones, joints, and muscles), thymus gland, heart, lungs, spleen and intestines, liver, gallbladder, pancreas, stomach, adrenal glands, kidneys, ureters, urinary bladder, prostate (male), rectum, testes (male), ovaries (female), uterus (female), vertebral column, and bone marrow.

    Optional autopsy incisions:

• Medial straight line incision which extends from the suprasternal (jugular) notch inferiorly to the cartilage of the pubic symphysis (fibrocartilaginous joint).
• Transverse T section which extends from the lateral third of the clavical (infralavicular fossa) to the opposite lateral third.
• A vertical incision is made from the suprasternal (jugular) notch to the pubic symphysis.
• Sub breast incision which extends from the auxiliary space under one breast, to the point of articulation of the xiphoid process (ensiform) under the adjacent breast, and then to the adjacent auxiliary space.
• A vertical incision is made from the xiphoid process to the pubic symphysis.
• Posterior spinal incision is a vertical incision made from the base of the skull to the sacrum.
• Anterior spinal incision is a wedge shaped cut in the vertebrae from the C1 to L4 from within the empty cavities.
• Cervical incision is made from the base of the skull to C1 to C7 or from ½ inch posterior to the ear lobes to ½ inch posterior lateral of the articular facet of the first thoracic vertebra extending transversely or superiorly across the inferior nuchal line of the occipital bone.

    Place organs after sectioning in a strong plastic bag and add preservative powder and absorbent then return the bag to the body cavities. Secure incision with one suture at the Y union.

CRANIAL AUTOPSY PROCEDURES

• Place the head in an adjustable head block.
• Part the hair if applicable.
• Begin incision in the scalp behind the middle third of the right ear.
• Extend incision over the vertex (crown) to the middle third of the left ear.
• Incision encircles scalp posteriorly within the hairline.
• Retract the scalp forward to a point superiorly above the supra orbital margins.
• Mark out line of incision indicating lateral and anterior notches,
• Cut temporal muscle and using stryker or hand saw open the calvarium.
• Remove brain, strip and clean vault, remove pituitary if applicable.
• Replace calvarium, scalp, and place one medial suture to hold everything in place.

    The reason for limited suture by a pathologist is to control possible leakage.
    ET-22 will cover treating of the body after the autopsy and analytical visualization.