After writing the February article, I noticed a post on a Facebook blog on “Getting those indents out of the hands where hospital tied the hands together” for transfer. Unfortunately, if this happens to you, I would recommend that you speak to the hospital about their protocol. A procedure that has been popular on removing these indents from the hands prior to embalming is using a pack of Webril saturated with a Humectant Injection Accessory chemical.
• Elevate the hands as in normal protocol
• Spray the entire hands with a Humectant Injection Accessory chemical.
• Place a pack of Webril saturated with Humectant Injection Accessory Chemical on those indents prior to embalming.
Not all Humectant Injection Accessory chemicals are produced in the same manner, so consult with your sales rep on how their product performs.
Have you noticed that as people age the tissue on the back of the hands becomes more fragile as a layer of fat that protects skin from bumps and bruises is lost?
Ecchymosis or hematomas are commonly known as a bruise. With blood thinners being widely used on the aging we see more bruising on the hands. Prednisone also thins blood and increases the chance of bruising. The back of the hand is a normal site for the IV line which may cause bruising. The removal of the IV after death can cause the blood to enter the interstitial tissue surrounding the small puncture site. Thin skin is easily damaged and any puncture to the tissue increases the risk of distention and swelling at the puncture site during embalming. Most ecchymosis or hematomas are caused by blood entering interstitial tissue space outside the normal vascular system.
Discolored areas may not clear with normal arterial injection. A simple way to test if the bruised tissue is a post-mortem discoloration or post-mortem stain is to apply digital pressure to the bruised tissue. If the blood moves out and clears from the tissue, this is a post-mortem discoloration also known as Livor Mortis. If the blood remains and is immovable, it is a stain. A stain will not be removed by arterial injection.
This month we focus on stained tissue and a lack of embalming solution reaching this tissue.
The use of transdermal hypodermic chemical treatments shown below can reduce the negative effect of this unstable tissue, making cosmetic treatment easier. This type of treatment has become popular to help alleviate stained areas and discolored tissues (bruises). It is recommended to be done prior to embalming because arterial injection could preserve and fixate the blood within the bruise and in surrounding areas. The vascular drainage of the blood in the bruised or discolored tissue area could be difficult to remove. Once the blood becomes fixated in these areas, a formaldehyde reaction with the hemoglobin in the blood could cause methemoglobin. This staining effect could be increased in darkness and intensity. The fixation effect from embalming will inhibit the true abilities of the bleaching action of these bleaching agent products. The bleaching procedure after embalming normally will become more difficult.
An additional concern is when little or no arterial injection reaches the bruised area. This lack of distribution could lead to un-preserved tissue in the bruised area which will actually get darker in color and allow the decomposition to progress.
The embalmer could consider hypodermically injecting (transdermally) a Phenol Based or Non-Phenol Based cauterant and bleaching agent into the stained areas. Using a small syringe and small gauge needle is recommended.
• Prior to hypodermic injection cover the area around the stained tissue with a protective layer of massage cream or spray a humectant injection accessory chemical around the bruise. Enter skin (transdermally) keeping the small gauge needle as superficial as possible in a fan-like manner.
• Enter the stained tissue at its furthest point and inject slowly, be careful not to overfill the discolored tissue area. If the tissue distends slightly, using digital pressure to disperse chemical into the area will help.
• The small gauge needle should be removed slowly and carefully to avoid any leakage of the chemical to the surrounding area. Any leakage should be controlled by the protective layer of massage cream or humectant injection accessory chemical. If these bleaching and cauterant products come in contact with unprotected skin from the leakage they could cause bleach spots or streaks to the surrounding skin surface.
• The transdermal injection procedure can be repeated if the discolored area is severe in nature.
The main difference between a Phenol based cauterant and bleaching agent and a Phenol-Free based cauterant and bleaching agent is the use of phenol. Phenol chemical bleaching and cauterant agents are more commonly used by mortuary embalming chemical companies. Phenol is the primary chemical used in most cauterant and bleaching chemicals. The advantage of Phenol–Free based cauterant and bleaching agents is that there is no Phenol odor. Phenol can be corrosive to the skin and the vapors are not considered safe. If you have spent any time in an embalming room you’re familiar with the unique phenol smell.
Both of these chemicals will bleach the discolored tissue. The advantage of both is that they will also preserve, cauterize and dry the tissue. The bleaching effect of these powerful chemicals causes the discolored tissue to become very light or white in appearance. It is easier to apply cosmetic treatments to lighter bleached tissue than dark discolored tissue.
To minimize the whitening effect, a few drops of eosine dye can be added to these bleaching products. The dye will give the bleached area more pink hue color instead of the whitening effect. It is easier to apply cosmetic treatments to cover pink hue tissue than white tissue.
The ability to stabilize these bruises through transdermal hypodermic chemical treatments will significantly simplify your cosmetic approach and add a more natural cosmetic coverage. If these skin discolorations are not treated, the skin will maintain the dark color and could become worse with skin slip and decomposition making cosmetic coverage difficult and resulting in a less natural appearance for families and friends.
In our next installment, we will continue the discussion of bleaching and cauterizing agents including the use of surface packs and treatments for discolored fingernails.