Journal List > Korean J Phys Anthropol > v.29(4) > 1039209

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

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.

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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.
kjpa-29-155f1.tif
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.
kjpa-29-155f2.tif
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.
kjpa-29-155f3.tif
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.
kjpa-29-155f4.tif
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
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
1 L of glycerin 5% by volume (glycerin) cycles, each 30 minutes
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
Normal FPF (n = 2) EGF (n = 3)
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
Bacteria Fungi Bacteria Fungi
FPF FP-1 Paenibacillus odorifer (1)
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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