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The First Incision…

When examining the body after death, the forensic pathologist needs to be very careful with how they open the body. Prior to this they photograph the body and complete their external observations, looking for telltale signs of trauma or injury that can help with their investigation.

Next, they want to delve under the skin to examine the organs. The body is placed on a dissecting table where there are holes to collect any leaking fluids. The head is propped up with a block to prevent purging. There are several ways of incising into the skin to expose the underlying structures. The most commonly employed skin incisions include the Y-shaped incision, the modified Y-shaped incision, and the I-shaped incision.

The Y-shaped incision - The arms of the Y extend from the front of each shoulder to the bottom end of the breastbone. The tail of the Y extends from the sternum to the pubic bone and typically deviates to avoid the navel. The incision is very deep, extending to the rib cage on the chest, and completely through the abdominal wall below that. The skin from this cut is peeled back, with the top flap pulled over the face.

The modified Y-shaped incision is when the top most incisions start from behind each ear down the sides of the neck toward the middle of the chest.

The I-shaped incision is a single straight vertical incision that goes from the top of the neck down the midline of the front of the body to the pubis

The forensic pathologist decides which incision suits them and the body on their table the best. Following this cut, the skin is gently peeled back to expose the ribs of the chest cavity. Rib cutters are used to cut the ribs laterally (to the sides) so that they can be removed in one piece. This is known as the thoracic shield. The organs are now exposed following the removal of the ribs. There is very little blood when these incisions are made due to blood no longer circulating in the body.

There are a number of different methods the pathologist can proceed with when examining the organs.

The Rokitansky method involves in situ dissection. This means examining and dissecting the organs before removing them from the body.

The Virchow technique involves the removal of organs one by one, starting at the cranium and moving down to the thoracic, abdominal, and reproductive organs. The organs are weighed and measured as they are individually removed.

The Letulle technique commonly referred to as the ‘en bloc’ technique is when the cervical, thoracic, abdominal, and pelvic organs are removed as one, and then subsequently dissected into organ blocks. This technique is good for preserving vascular supply and relationships between organs.

The Gohn method involves the removal of viscera in different sections, specifically the thoracic, intestines, upper abdominal, lower abdominal, brain and neck.

The Rokitansky method involves removing the body organs all at once That is, the heart, lungs, liver, kidneys and spleen etc are removed in one block and then dissected on the autopsy table. The organs are dissected one by one and during the examination, the forensic pathologist will collect small samples of tissue for further examination under the microscope.

All the organs are weighed and measured in each of these methods. They are all looked at and examined closely regardless of how the pathologist does it. Necessary samples are taken for further investigation.

A separate incision is made for examining the head. To remove the brain, an incision is made in the back of the skull from one ear to the other. The scalp is cut and separated from the underlying skull and pulled forward. The top of the skull is removed using a small electric circular saw. The entire brain is then gently lifted out of the cavity. This method of removing the brain and sectioning the skull is done so very gently and close to the hairline. This allows for viewing of the body by loved ones as the incision marks can be discretely hidden.

As you can see there are a lot of different methods involved in performing a post-mortem. Expand your knowledge and get involved by attending one of our events coming to a city near you!

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