Internal examination

REMOVAL OF INTERNAL ORGANS

Following external examination, the person involved in examining the dead body must make sure all the safety measures are followed including use of PPEs. All the instruments must be sharp and uncontaminated.

A primary shallow incision is initiated at the base of the chin along anterior midline. The scalpel is then continued over the neck making sure not to injure underlying neck structure. The incision is then continued over the thorax where sternum prevents injuries to underlying structures, but extra care must be taken while one passes scalpel along the abdomen.

Only a light cut should be made, just sufficient to cut through skin and adipose layer exposing parietal peritoneum. A small puncture is made in the peritoneum and forefinger and middle finger of one hand is inserted through the hole to lift it. A scissor or knife is inserted and cut along anterior midline, guided the by inserted fingers. This procedure can prevent puncturing the intestines and developing artefacts, causing fluid leakage and bad odor.

Incision given to access skull is called coronal incision and it extends from above one mastoid to another passing through top of the head. It is better to keep the incision posteriorly to make stitching less visible, where hair is abundant. Hair should be wet, combed and parted, to avoid severing, and following stitching, can be combed back to hide the stitch marks.

Umbilicus must be spared while making initial incision over the abdomen, for cosmetic purpose as it becomes difficult to stitch later and could lead to leakage of materials.

Incisions

  • Midline ‘I’
  • Modified ‘Y’ (Bloodless dissection of neck)
  • ‘Y’ – sub-clavicular