Preservation Through

Cadaver Perfusion
Rizki Perdana
Magister Ilmu Kedokteran Dasar
FK UNPAD
Introduction
Cadaver:
distinct educational tool (first patient vs biological model);
non vital, morbid and mortal;
3 dimensional low health hazard & high quality of haptic
experience
Restricted availability & moderate costs per student
Can not be harmed, & ethically fine
Urge for re-enhancing anatomical education despite
vast virtualization
Preservation: for safe from harm, destruction/
decomposition
History
Embalming & mummification (1500 1200 BC) by
Egyptians, Andes, Buddhist, South American (Jivaro-
Shuar Tribes, shrinking human head)
Shool of anatomy in Greece by Erasistratus (304 250
BC) & Herophilus (330 250); in Russia, Czar Peter &
Frederik Ruysch (1638 1731)
Ruysch: combination of alcohol, wine, and pepper for
preservation
Ferdinand Blum of German (1865 1959):
Formaldehyde for disinfection properties
Gunter von Hagens of German: plastination (active
polymer), superior than formaldehyde yet high cost and
extensive preparation
Material & Methods
In The Duke Human Fresh Tissue Laboratory (30
35 cadaver/year). Fresh cadaver 36 hours in
refrigerated facility.
Perfusion inclusion: no bleeding, open wound or
artificial opening
Exsanguination (blood letting) by Super Jugular
Drain TubeTM (California Professional
Manufacturing, Modesto, CA). 5 10 mm into
internal jugular vein sucked 80 mmHg. Limb
elevated. 4,5 L (40 50 mL/Kg) removed
 Insertion of one ESCO anticoagulant softener solution
(The Embalmers Supply Company, Ontario, Canada)
and four part of water into common carotid artery via
tube 2,5 5 mm with centrifugal pump (260 mmHg)
Same time with blood drainage color changes from
internal jugular vein indicate adequate exsanguation
Jugular drain tube removed and vessels tied.
Insertion of ESCO EPIC Conditioner (The Embalmers
Supply Company, Ontario, Canada) w/ methyl alcohol
(1:2) pumped at 260 mmHg 25 mL/Kg
Kept frozen (-180 C)
 For latex vasculature injection by red or blue latex
(Wards Natural Science, Rochester, NY) instead
mixture of ESCO EPIC Conditioner & methyl alcohol
Pumped latex in 35550 C for 24 hours then freezed
in 180 C.
All organ left uninterrupted
For brain tissue, injection of 60 mL 10% formalin
needed via 16 mm frontal region hole, and storage
at 35550 C for 24 hours
 If thawed, last for 30 days. If directly used without
00 C (freezed), last for 45 days (refrigerator
temperature 1 40 C, lab temperatures 13 160 C
with a 10 PPH negative air flow)
body parts kept covered with towels dampened
with tap water to prevent dehydration
 Preservation of joints.
A, Anterior view of
disarticulated
radiohumeral joint
following latex
injection. Note
excellent preservation
of vasculature
overlying
lateral epicondyle. B,
View of the
radiohumeral joint,
note the cartilage
erosion on the radial
head (arrow), the
open articular capsule
lined with the
synovialmembrane,
and a synovial fold
(arrow).
 Preservation of skin and muscles. A, B, View of the
dorsal and palmar aspect of the hand prior to dissection
shows intact surface anatomy and skin creases. Note the
relation of the creases to the underlying joints and the
thick and ridged skin of the palmar surface. C, Cross
section of the upper arm shows well-preserved muscles,
bone, and skin.
Discussion
Preparation time aprox 4 - 6 hours/ body
Less mummified resilience and more natural feel to
the tissue
This new process for preservation of tissue suited
for study and training as well as numerous research
opportunities
Refference
Caroline Messmer, et al. A Technique to Perfuse
Cadavers That Extends the Useful Life of Fresh Tissues:
The Duke Experience. Anat Sci Educ. 2010, 3:19119.
Erich Brenner. Human body preservation old and new
techniques. J. Anat. 2014, 224: 316 3044.
Rosane MGS, Julia MM, Antonio ACMR. Preservation of
Cadavers for Surgical Technique Training. Veterinary
Surgery. 2004. 33:606608.
Joy YB, et al. Human preservation Technique in
Anatomy: a 21st Century Medical education
Perspective. Clinical Anatomy. 2015, 28: 725 734.