Embalming and Maintenance of a Pliable Cadaver Over a Two‐Year Period for Clinical Procedure Learning
Authors: Zhu Jiepei , Sikon Richard , Rarey Kyle E. , Nonabur Venkatesh E. , Gravenstein Nikolaus , Smith Cameron R. , Le‐Wendling Linda T. 
Published: May 2022

Introduction

Soft Cue Embalmed (SCE) cadavers can be used in various procedure learnings, such as ultrasound guided regional anesthesia (UGRA), laparoscopic, orthopedic surgeries, and developing new equipment and surgical approaches. However, the SCE technique is not well known in Northern America due to lack of knowledge to make a SCE cadaver and because the original Thiel method (1992) needs a highly specific sequence, quality, and quantity of fluid injection with a long submersion. The aim of the project is to develop SCE cadavers in the Anatomical Board of the State of Florida’s facility for the residents’ procedure learning at UF.

Methods

The SCE method (Sikon & Boaz 2012, unpublished) was used. Briefly, the donor was first perfused with 8‐liter Freedom Art (Formalin free, The Dodge Company), followed with Surgical Reality Fluid (SRF, Trinity Fluids, LLC) perfusion. 4‐gallon SRF was perfused with a pressure of 10 lb/ft over 90 minutes, then 1‐gallon SRF was to freely drip overnight. The completed SCE body was bagged and kept at room temperature for 4 weeks. The body was rinsed with soap and water at 2 weeks post SCE to remove the loose stratum corneum. Maintenance included monthly vacuuming extra transudate fluid in the 1 year, and spraying with SRF to prevent dehydration with wrapping film covering the donor in the 2nd year.

Results

The 1st donor with SCE was 8 days postmortem without receiving pre‐conditioning perfusion which decomposed in 30 days after SCE. The 2nd donor was SCE prepared 2 days postmortem, and pre‐perfused with SCE following the preservation protocol restoring an intact fresh lifelike cadaver. Qualitatively, ultrasound images from the SCE cadaver were highly similar with those from a living person. Nerve, fascia, ligaments, vasculature and muscle images were clearly and easily identified. Skin elasticity and texture were lifelike. The successful SCE cadaver was stored and maintained for 25 months (2019 to 2021), which provided a long‐lasting lifelike simulating platform for procedure learning. Using SCE cadaver, ultrasound guided procedure learning included UGRA, lung ventilation, chest tube placement & pericardiocentesis, and exploration of a novel prostate biopsy training. Other procedures included the dissection of hand & facial areas as compared with formaldehyde embalmed donor, tracheal tube intubation, tracheotomy, and suturing practice during students' clerkships. There was no significant difference in CT images before and after SCE.

Discussion

The modified and simplified SCE method can make a “Thiel cadaver” more efficiently. Using a SCE cadaver, a learner can exercise hand‐on skill in a near‐real condition without psychological pressure and learning time can be individualized, which greatly increases the beginning learner’s confidence to master the procedure before working with patients. One SCE cadaver can be shared in various procedure training. Further, quantitative studies will be designed to optimize procedure learning. Integrating SCE cadavers into current simulation training programs appears both feasible and desirable.