Suitability of Ethanol-Glycerin Embalming Cadavers for the Training of Human Anatomy

Sam Sik Shin; Hyung Chae Yang; Kwang Il Nam

doi:10.11637/kjpa.2016.29.4.155

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Shin, Yang, and Nam: Suitability of Ethanol-Glycerin Embalming Cadavers for the Training of Human Anatomy

Original Article

Korean J Phys Anthropol 2016;29(4):155-165.

Published online: 20 January 2016

DOI: https://doi.org/10.11637/kjpa.2016.29.4.155

Suitability of Ethanol-Glycerin Embalming Cadavers for the Training of Human Anatomy

Sam Sik Shin¹, Hyung Chae Yang², Kwang Il Nam^1,

¹Department of Anatomy, Chonnam National University Medical School

²Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School

Correspondence to: Kwang Il Nam (Department of Anatomy, Chonnam National University Medical School) E-mail: atlas@jnu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study evaluates the suitability of cadavers embalmed by the ethanol-glycerin fixative for the dissection course of medical students and the hands-on dissection workshop of clinicians. Five cadavers were embalmed by two different methods: two formalin-phenol fixation (FPF) and three ethanol-glycerin fixation (EGF) cadavers. The measurement of physical and chemical characteristics including ranges of motion (ROM), bacterial and fungal culture tests, and ultrasonography were performed for each cadaver.

The EGF cadavers were evaluated to be significantly more suitable than FPF cadavers for the physical and chemical characteristics including color, texture, elasticity, wetness (softness), skin incision, vessel ligation and suture, decollement, odor, and irritant. In shoulder, elbow, and wrist joints, ROMs of the EGF cadavers were statistically more than those of the FPF except for elbow extension. On bacterial and fungal culture tests at 8 weeks after carrying out of refrigerator, one bacteria were detected in one EGF cadaver; however, some bacteria and fungi could be detected in all FPF cadavers. The ultrasound images of abdominal organ and thigh musculature could be more clearly detected in the EGF cadavers than those of FPF cadavers.

These results indicate that the EGF method had a sufficient antibiotic effect and produced cadavers with flexible joints and a high tissue quality suitable for various cadaveric dissection courses.

Keywords: Cadaver, Ethanol-glycerin fixation, Formalin-phenol fixation, Dissection

References

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Fig. 1.

Time frame of study design. FPF: formalin-phenol fixation, EGF: ethanol-glycerin fixation, HSEA: high-speed embalming apparatus, Fridge: carrying cadavers out of the refrigerator, P&T: All procedures and tests, 2°CT: second culture test, wk: week.

Fig. 2.

Assessment of physical and chemical characteristics in cadavers embalmed by two different methods. (A) to (B) are formalin-phenol solution-fixed cadavers, whereas (C) to (F) are ethanol-glycerin solution-fixed cadavers. (A) and (D): skin incision and decollement; (B): vessel ligation; (E): small intestine; (C) and (F): the vasculature of meninges and brain.

Fig. 3.

Assessment of the range of motion in cadavers embalmed by two different methods. (A) to (C) are formalin-phenol solution-fixed cadavers, whereas (D) to (F) are ethanol-glycerin solution-fixed cadavers. (A) and (D): shoulder abduction; (B) and (E): elbow flexion; (C) and (F): wrist flexion.

Fig. 4.

Ultrasonography in cadavers embalmed by two different methods. (A) to (C) are from the formalin-phenol solution-fixed cadavers, whereas (D) to (F) are from ethanol-glycerin solution-fixed cadavers. (A) and (D) images through right upper quadrant in abdomen; (B) and (E) images through pelvis; (C) and (F) images through right thigh.

Table 1.

General characteristics of donated cadavers

No.	Age	Sex	Cause of death	Embalming method
FP-1	88	Female	CPA	Formalin-Phenol
FP-2	87	Male	Septic shock	Formalin-Phenol
EG-1	95	Female	Respiratory failure	Ethanol-Glycerin
EG-2	69	Female	Lung cancer
EG-3	76	Male	Prostatic cancer

CPA: cardiopulmonary arrest.

Table 2.

The protocol of formalin-phenol fixation summarizes the amounts and concentrations of fixatives, duration of each step, and required conditions

Procedure	Amount of fixatives	Final concentration	Duration	Required conditions
Formalin-phenol fixation	10 L of ethanol	27% by vol. (ethanol)	18 hours: 4 to 6 injection cycles, each 30 minutes	Injection pump
	3 L of glycerin	8.3% by vol. (glycerin)
	3 L of formalin	8.3% by vol. (formalin)
	2 kg of phenol	5.6% by mass (phenol)
	18 L of water	50% by vol. (water)
Wrapping and storage	–	–	Up to 2 years	4℃, refrigerator, polyethylene foil

Table 3.

The protocol of ethanol-glycerin fixation and thymol conservation summarizes the amounts and concentrations of fixatives, duration of each step, and required conditions

Procedure	Amount of fixatives	Final concentration	Duration	Required conditions
Ethanol-glycerin fixation	19 L of ethanol	95% by volume (ethanol)	18 hours: 4 to 6 injection	Injection pump
Ethanol-glycerin fixation	1 L of glycerin	5% by volume (glycerin)	cycles, each 30 minutes	Injection pump
Fixation of skin	Water-diluted ethanol, immersion	65% by volume	2 weeks	37℃, high-speed embalming apparatus
Wrapping and storage	–	–	Up to 2 years	4℃, refrigerator, polyethylene foil
Thymol conservation	0.3 kg of thymol (2 mol) and 1 L of ethanol	∼3% by mass (thymol) ∼9% by volume (ethanol)	Moistening≥once a week	Polyethylene foil to prevent drying

Table 4.

Comparison of the physical and chemical characteristics in cadavers following embalming by two different methods

Characteristics	FPF (n = 2)	EGF (n = 3)	P value
Physical
Visual assessment (gross)	3.73±1.90	7.22±0.99	∗∗
Visual assessment (gross) Color	3.73 1.90 3.73±1.79	7.22 0.99 7.47±1.03	∗∗ ∗∗
Texture	3.64±1.57	7.31±1.06	∗∗
Elasticity	2.82±1.60	7.11±1.33	∗∗
Wetness (softness)	4.55±2.34	7.64±1.50	∗∗
Skin incision	5.27±1.79	7.53±1.63	∗∗
Skin suture	5.40±1.14	6.42±1.98	ns
Vessel ligation	3.00±0.00	7.67±0.58	∗
Vessel suture	3.00±0.00	7.93±0.58	∗
Decollement	5.45±1.21	7.93±0.87	∗∗
Usefullness of surgical training	3.50±2.22	7.94±1.32	∗∗
Chemical
Odor	3.55±1.70	7.64±1.90	∗∗
Irritant	4.09±1.58	8.12±1.41	∗∗

All items are evaluated on a 10-point rating scale (Ten point represent the similarity to living condition).

FPF: formalin-phenol fixation, EGF: ethanol-glycerin fixation, Values are represented as mean±SD. ns: not significant (P>0.05),

^∗ : 0.01<P<0.05,

^∗∗ : P< 0.01.

Table 5.

Range of motion (ROM) of joints in cadavers following embalming by two different methods

Joint movement		ROM (angle)			P value
Joint movement		Normal	FPF (n = 2)	EGF (n = 3)	P value
Shoulder	Flexion	∼180	32.5±17.7	135.0±25.0	∗
	Abduction	∼180	30.0±14.1	146.7±12.6	∗∗
	Medial rotation	∼70	32.5±17.7	83.3±11.6	∗
	Lateral rotation	∼90	20.0±14.1	83.3±5.8	∗∗
Elbow	Extension	0	0.0±0.0	– 6.7±5.8	ns
	Flexion	∼150	70.0±0.0	153.3±5.8	∗∗
	Extension	∼70	25.0±7.1	80.0±0.0	∗∗
Wrist	Flexion	∼80	20.0±14.1	80.0±0.0	∗∗
	Supination	∼80	20.0±14.1	90.0±0.0	∗∗
	Pronation	∼80	65.0±7.1	90.0±0.0	∗∗

FPF: formalin-phenol fixation, EGF: ethanol-glycerin fixation, Values are represented as mean±SD. ns: not significant (P>0.05),

^∗ : 0.01<P<0.05,

^∗∗ : P< 0.01.

Table 6.

Results of bacterial and fungal culture tests on cadaver following two different embalming methods

Cadavers		4 wk		8 wk
Cadavers		Bacteria	Fungi	Bacteria	Fungi
FPF	FP-1	–	–	Paenibacillus odorifer (1)	–
FPF	FP-2	–	–	Staphylococcus capitis (1)	Penicillium species (15)
EGF	EG-1	–	–	Bacillus circulans (1)	–
	EG-2	–	–	–	–
	EG-3	–	–	–	–

FPF: formalin-phenol fixation, EGF: ethanol-glycerin fixation.

The Number in parenthesis indicates the number of colony on culture tests.

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