E-10 will deal with guidelines for secondary vessels and will include additional linear guidelines for the embalmer.
Secondary Vessels for Vascular Injection
Facial Artery – An imaginary guideline for the Facial artery is from the inferior border of the angle of the mandible, anteriorly along the inferior border of the body of the mandible just beyond the inferior mandibular notch (maxillary notch). The distance is determined by digital pressure. The incision is made between the anterior and posterior borders of the notch (1/4 of an inch). Used when an obstruction occurs preventing facial distribution of the embalming chemical or when the organs of the neck and throat have been removed during an autopsy.
Ulnar and Radial Arteries – An imaginary guideline for the Ulnar and Radial arteries is an extension of the axillobrachial guideline passing through the center of the anti cubital fossa where the brachial bifurcater into the radial and ulnar arteries. The anti cubital is located 2/3 of an inch below the bend of the elbow (forearm). The incision may be made vertical or transverse through the center of the anti cubital space. At this point, using the terminal section of the brachial, both the radial and ulnar may be injected at the same time. From this same point, the practitioner can inject either the radial or ulnar arteries.
Ulnar Artery – An imaginary guideline for the Ulnar artery is 2/3 of an inch below the bend of the elbow (anti cubital fossa) on the anterior surface of the forearm just above the annular ligament (wrist) above the little finger. The incision is made between the tendons of the flexor carpi ulnaris and the flexor digitorum sublimis which may be defined by digital pressure.
Radial Artery – An imaginary guideline for the Radial artery is 2/3 of an inch below the bend of the elbow (anti cubital fossa) on the anterior surface of the forearm just above the annular ligament (wrist) above the center of the ball of the thumb (thenar eminence). The incision is made between the flexor carpi radialis and the supinator longus muscle (lateral to the tendon of the flexor carpi radialis).
External Iliac Artery – An imaginary guideline for the External Iliac artery begins at a point about ½ of an inch to the left of the umbilicus to a point in the middle third of the inguinal ligament. The superior portion represents a guideline for the common iliac artery which is important in embalming the autopsied body. The lower portion represents the guideline for the external iliac artery one inch above the middle third (center of the inguinal ligament (poupart’s ligament). The incision is made along this guideline where the external iliac is most superficial.
Popliteal Artery – An imaginary guideline for the Popliteal artery is through the center of the popliteal space posterior to the bend of the knee. The incision is made along the medial side at the bend of the knee to avoid the large number of muscle attachments in the region.
Posterior Tibial Artery – An imaginary guideline for the Posterior Tibial artery is from the inferior border of the popliteal space to a point between the medial malleolus (inner ankle) and the calcaneus (heel). The incision is made between the inner ankle and heel.
Anterior Tibial Artery – An imaginary guideline for the Anterior Tibial artery is from the center of the popliteal space to a point between medial malleolus (medial ankle joint) and the lateral malleolus (lateral ankle joint) between the big toe and the next toe. The incision if made high on the instep 1 ½ inches below the annular ligament of the ankle or 2 inches above the annular ligament along the flat lateral side of the tibia.
Dorsalis Pedis Artery – An imaginary guideline for the Dorsalis Pedis artery is from the center of the ankle on the instep to a point between the big toe and the next toe.
Axillary Artery – An imaginary guideline for the Axillary artery is from the infra clavicular fossa (outer border of the first rib) to the beginning of the bicipital grove (teres major Muscle). The incision is made along the anterior margin of the hairline.
Brachial Artery – An imaginary guideline for the Brachial artery is bicipital grove. The incision is made between the biceps and triceps muscles. This has become a preferred injection point allowing for natural positioning of the arms and hands. Drainage point would be the practitioner’s option.
Femoral Artery – An imaginary guideline for the Femoral artery is from the middle third (center) a point midway between the iliac spine (crest) and the symphysis (pubic) of pouart’s or inguinal ligament to the inner prominence of the knee joint (medial epicondyle). The upper third being scarpha’s triangle or femoral trigone and the linear guide for the femoral artery. To locate the Femoral artery the practitioner may place his/her thumb on the superior crest of the ilium and the little finger of the crest of the pubic bone, the index finger pointing toward the middle of the knee and will indicate the position where the femoral incision should be made (along the linear guide).
Additional Linear Guidelines for the Embalmer
Abdominal Aorta – An imaginary guideline for the Abdominal Aorta is from a point ½ inch below (posterior) and ½ inch to the left of the umbilicus in an upward direction for 5 or 6 inches gradually sloping toward the median line (vertebrae). Used as a site for infant embalming. The abdominal aorta terminates at the 3rd and 4th vertebrae where it bifurcates into the right and left common iliac.
Common Iliac and External Iliac - An imaginary guideline for the Common iliac and External iliac is from ½ inch below and ½ inch to the left of the umbilicus to a point ½ inch medial to the middle of the right or left inguinal ligaments. The upper halves of these linear guidelines will represent the linear guidelines for the common iliac arteries and the lower halves of the linear guidelines will represent the linear guidelines for the external iliac.
Common Iliac and Internal Iliac – An imaginary guideline for the Common iliac and Internal iliac is from ½ inch below and ½ inch to the left of the umbilicus to a point 1 ½ to 2 inches to the bifurcation of the external and internal iliac (hypo gastric) which sends numerous branches to the buttocks, pelvic walls, pelvic viscera and the external genitalia. Common problem is the internal iliac is nicked or cut during a post mortem examination.
Internal Carotid/Middle Cerebral – Located on both sides of the sella turcica on the floor of the cranial vault. To expose the internal carotid/middle cerebral of the sella turcica must be chipped away opening the spheroidal sinuses providing necessary length of vessels to secure arterial tubes. Reverse injection will provide distribution to the inner eye and inner ear. For proper distribution, the most inferior portion of the internal carotid must be tied off.
Part 11 will deal with guidelines for veins used for drainage or injection.