In our last installment we spoke about the power of bleaching agents on dealing with bruises or stains on the hands or arms as a pre-embalming treatment.
A new product that has been getting a lot of attention is a phenol-free cauterant and bleaching gel. The absence of phenol results in a highly effective bleaching product that is odor free. This phenol-free gel is innovative among cauterizing and bleaching products. The thicker consistency allows this product to stay in contact with the affected tissue. Using phenol free gel as a surface bleaching agent may require the embalmer to allow additional time for the optimal effect. The same protocol used with a bleaching surface pack should be followed with a phenol-free gel with the additional step of covering the hands with plastic. Since this product is a gel that is both phenol free and odor free many embalmers may be inclined to not cover the product when applied. I personally like to control any chemical evaporation and will cover with plastic. The new phenol-free based gel provides outstanding cauterizing and bleaching results without the nuisance of offensive phenol odors.
Arterial chemicals and cavity chemicals are generally not considered as an ideal option for either pre-embalming or post-embalming bruise treatment. Arterial chemicals are not formulated for these types of treatment and normally do not result in the optimal bleaching and penetrating effect as transdermal hypodermic or surface pack techniques.
A cavity chemical may be employed as a last resort if a bleaching product is not available. The main drawback with the use of cavity chemicals for bleaching is that they are mainly formulated to preserve and dry tissue so they are normally very astringent. The bleaching aspect of cavity fluid is nothing like using bleaching products resulting in the tissue becoming very dehydrated. If using a cavity pack or transdermal hypodermic technique to bleach a bruise you are likely to encounter difficulty with cosmetic coverage and the tissue will appear less natural.
These factors all highlight the importance that the techniques the embalmer chooses to lighten a bruise and make certain that the tissue is chemically stabilized for cosmetic application and a more natural appearance play in the appearance of the loved one’s hands. This extra work will pay off in the long run.
A common postmortem effect seen in the hands is settling effect of blood. This is especially noticeable in the finger nail beds. As blood vessels become more permeable from decomposition, blood settles in dependent areas and can lead to post mortem staining of the tissue. Pressing on the finger tips can determine if the tissue is stained. While applying pressure to the fingertips, if the pooled blood in the fingernail beds becomes blanched (white) easily, then the tissue is still in a state of livor mortis and may be able to be removed via arterial embalming.
We can see blue finger nail beds in pre-embalming scenario as well as post embalming scenario. This can occur if the fingernail bed discoloration has not been treated as a pre-embalming technique and arterial embalming was performed. The vascular drainage of the blood in the fingernail bed frequently results in discolored tissue area that may be difficult to remove during embalming. Once the blood becomes fixated in these areas a formaldehyde reaction with the hemoglobin in the blood could cause methylehemoglobin. This staining effect may be increased in darkness and intensity. This reaction makes the finger nail bed discoloration more difficult to remove with a post embalming procedure or cosmetic coverage.
The most important aspect is preservation before coloration techniques are considered. We must remember the blood in the nail bed if not treated, will begin to break down and can lead to decomposing tissue.
A rather popular way to bleach the darkened finger nail beds prior to embalming is to inject a bleaching agent superficially under the nail into the nail bed. A popular technique is a diabetic needle with phenol-free cauterant and bleaching product and few drops of eosine dye. The dye will allow the bleached area to have a more pink hue. Any attempt to bleach the nail beds will make it easier to cover with cosmetic and chemically stabilize the tissue. It’s always much easier to cover light tissue rather than dark tissue. The few drops of eosine dye will give it a colored pink hue. This will help with cosmetic effects to the fingertips. Prior to superficial nail bed injection, spray each fingernail area with humectant injection accessory chemical. Massage cream can also be used and any other humectant accessory chemical if deemed for topical use. This will condition the tissue and will protect the tissue around the finger tip from any un-wanted leakage of the bleaching chemical. Since we have the protective layer of humectant accessory chemical or massage cream any leakage should be controlled. If any bleaching or cauterant product contacts unprotected skin the leakage could cause bleach spots or streaks to the surrounding skin surface.
In our next installment, we will discuss laceration wounds and traumatized sutures of the hands prior to embalming.