In our last installment, we reviewed pre-embalming treatments of traumatized laceration wounds and sutures in the areas of the hands.

  As we continue looking at pre-embalming techniques for the hands, we will focus on abrasions. As mentioned in prior installments, along with age comes thinning of epidermal layer of the hands, however, we see abrasions in all ages because the tissue of that area of the body is extremely delicate and very prone to abrasion.

  By definition, an abrasion is a wound caused by superficial damage to skin, no deeper than the epidermis. There are dry abrasions and wet abrasions. A dry abrasion is an area of dehydrated tissue that is dark and rough and resembles a scab. A moist abrasion is an area leakage. The area will be wet to the touch and can have some bruising present.

  When treating any type of abrasion, cleaning and disinfection are normal protocol. This should be followed by spraying the hands with humectant arterial injection accessory chemicals or massage cream. This helps protect the entire hand area and will prevent any crusting or dehydration. Most dry abrasions can be treated with these topical treatments followed by embalming process. If scabs are present, it is advised not to remove them.

  Most abrasions are very superficial and normally only affect the epidermis layer of the skin. Wet abrasions often have seepage, raw skin or a small amount of bruising present. Spray the hands and the wet abrasion with humectant arterial injection accessory chemicals or massage cream. This helps protect the entire hand area and will prevent dehydration of the raw skin.

  Once we have topically conditioned the area, embalming can proceed. Normally embalming fluid will reach these abraded areas and it will preserve the tissue. Small amounts of arterial leakage can be present during the embalming procedure. Since we have topically conditioned, the entire hands are protected from the small amount of leakage. A post embalming treatment may be necessary if leakage or preservation problems were not fulfilled during embalming.

  Burns to the hands caused by heat, chemicals, electricity or radiation are classified into 1st, 2nd and 3rd degree burns. Embalmer discretion and case analysis is important.

•     1st degree burns only cause redness of the epidermis. This type of a burn is very superficial.

•     2nd degree burns have blisters and swelling (edema) to the area. There is destruction of the tissue of the epidermis and dermis.

•     3rd degree burns destroy layers of skin and tissue. A charring effect and destruction of the skin is present.

  Preservation is the primary concern when faced with 2nd and 3rd degree burns. Since we are dealing with pre-embalming techniques for burns of the hands only, we will only focus on generalized location of burn not the total system effects a burn can have on the body. Pre-embalming treatments depend on the degree of the burn. Burn victims frequently will survive the initial burn event and live for some time. Initial concerns are, depending on the severity: severe infection, localized edema, trauma, charring and loss of tissue.

  General guidelines for pre-embalming treatments for 2nd degree burns include:

•     Thorough washing, cleaning and disinfection of the localized burns on the hands. This can be performed with a topical embalming spray and a germicidal soap.

•     Spray the entire hand area with humectant arterial injection accessory chemicals or massage cream. This will help condition skin that is not damaged from topical preservation treatment and will condition and protect the skin. Remove these conditioners from the burnt tissue only. Re-spray with topical embalming spray.

•     If blisters are present, puncture pouches of liquid and allow to drain. This can be accomplished with a transdermal needle injection into the blister in a fan like manner. This will allow drainage of liquid during arterial injection.

  Many times a case analysis needs to be re-assessed to see if arterial preservation will reach these areas. A frequent complication with burn victims is difficulty with circulation and high preservation demands. We have to remember we need a preserved, firm and dry tissue for restoration and cosmetic treatment.

  We are generally speaking of a 2nd degree localized burn of the hands. A popular treatment is painting the burned area with a formaldehyde preservative gel. This treatment should be planned as a multi-step approach and should be done prior, during and after embalming. This technique is an effective option and causes very little bleaching effect.

  Another pre-embalming technique is using a phenol/ non-phenol cauterant pack wrap or a non-phenol cauterant gel on the burned areas. The areas should then be covered. This technique will have a bleaching effect.

  A popular technique used for damaged tissue in various cases, including 2nd and 3rd degree burns on the hands and elsewhere, is painting the burned areas of the hands with a super gel mixture. The phrase super gel has become well known in our industry and refers to a mixture of formaldehyde preservative gel and a phenol liquid cauterant mixed in stainless bowl. This mixture can be used as pack or painted over the burned area and covered. These pre-embalming treatments for abrasion and burns can help with preservation and cosmetic applications.

  In our next installment, we will discuss pre-embalming treatments prior to embalming.