Last month’s column looked at the power of non-phenol based bleaching gel and bleaching of the fingernail beds as a pre-embalming treatment. This installment will focus on pre-embalming treatments of traumatized laceration wounds and sutures in the areas of the hands.

  When planning and executing a pre-embalming treatment, the embalmer’s primary objective must always be preservation. Without a solid foundation of good preservation, family satisfaction at the viewing is simply a gamble. The embalmer can have no control over what will happen after the body leaves the prep room unless you have taken the required steps and laid a foundation of good preservation. Additionally, cosmetic treatment and restoration are very difficult if you are not starting out with good preservation base. Simply stated: Preservation before coloration. Case analysis is the key to success as there are many factors to take into consideration regarding the hands.

  With age comes thinning of the epidermis on the back of the hands. Since this thin tissue is fragile, a suggested habit to employ is spraying the entire hand with humectant arterial accessory chemical prior to pre-embalming techniques. This moisture layer will protect hands from inverted damage or trauma caused during pre-embalming treatments and manipulation. This thinning layer of epidermis is easily damaged often resulting in small tears in the tissue. Left untreated with massage cream or humectant arterial accessory chemical initially these small tears in the epidermis are likely to dehydrate and turn brown when exposed to air.

  We frequently see sutures from medical treatments and laceration wounds on the hands that require special treatment prior to embalming. The degree of treatment for these lacerations, suture marks or holes on the hands depends of the severity of the damage. A suture or laceration that shows any signs of decomposition, pooled blood, livor mortis, stains or trauma in the area of the laceration should be cleaned then chemically stabilized. A laceration wound that is deep and severe may also be treated with a pre-embalming treatment. With staph infection so common in medical institutions, a pre-embalming treatment is advised; if staph infection is not treated these simple traumas could end up causing decomposition in the tissue.

  A few guidelines on treating severe laceration wounds or traumatized sutures with problems:

•     Assessment of the laceration wound or suture (case analysis)

•     Pre-Embalming treatment or post embalming –treatment required?

•     Cleaning laceration wound or suture, removal of sutures if necessary, removal of dried blood or dirt.

•     Flush with tepid water and germicidal soap.

•     Cleanse area with topical disinfection spray.

•     Condition hands with massage cream or humectant accessory injection chemical around the laceration or suture to prevent unwanted bleaching of normal tissue.

•     Pre-Embalming chemical stabilization of the Laceration wound or traumatized suture.

•     Use transdermal injection of a cauterant into the laceration and surrounding tissue

•     Cauterant pack around and inside of the laceration or suture

•     Cauterant gel in and around laceration or suture

•     Topical embalming preservation into and around laceration wound or traumatized suture.

•     Cavity fluid pack around or inside the laceration wound or suture.

  As noted in a prior article, the phenol or non-phenol products are preferable to formaldehyde packs or gels on any type of laceration or suture. The ability to cauterize, bleach, dry and preserve has its benefits and this is an advantage over cavity packs or formaldehyde gels. The cauterizing treatment of laceration wounds or traumatized suture areas in the skin helps control leakage during embalming. The embalmer should always be striving to dry and preserve tissue.

•     Depending on the lacerations or sutures some debridement might be necessary. Lacerations commonly consist of ragged, torn tissue with trauma present. Suture areas can also be irregular or jagged or rough.

  A suture that is unbroken and not traumatized can often be treated with massage cream or humectant accessory injection chemicals. Until you perform your post embalming restorative treatment this will prevent shrinkage and separation of the skin during and after embalming.

  Once the laceration wound or suture area is cleaned, disinfected and chemically stabilized, the embalmer moves to the next step.

  I have found over the years that many embalmers like to temporarily close a laceration wound or suture prior to embalming. This can be done with a fast setting adhesive, available with accelerators/activators to increase the curing speed of the adhesive. These products are quicker and more efficient than over the counter glue.

  Temporary sutures or subcutaneous sutures are difficult to use because the tissue on the hands is rather thin. These closures can cause puckering of the area when the edges are drawn together prior to embalming. When the injection portion of the embalming begins the protein fixing action of the process will help with a natural closure of these areas. Keep in mind that during arterial embalming leakage could occur at any of these trauma sites. On a severe deep laceration of the hands a bridge suture and temporary use of fast setting glue may be needed to close these deep lacerations before embalming. If a deep laceration is kept open during embalming, the fixation action of embalming will likely make closure of the deep laceration difficult and un-natural in appearance once closed.

  In our next installment, treatment of abrasions and burns on the hands prior to embalming will be discussed.