FMT-06 · A teaching tool for forensic medicine
Step by step dissection of the individual organs at autopsy — how each one comes out, how it is held, where the cut goes, and why that plane and no other.
Fifteen organs, each set out the same way: the block it leaves the body in and why, what is done before any cut is made, how the specimen is held, the accepted method or methods of section with the reason for choosing between them, the cautions, what is being looked for, what gets missed, the normal weights and measurements, and what is preserved.
The tool is pitched at two levels. MBBS gives nine organs with one accepted technique for each, the normal weights, and the mistakes that are actually made. MD and postgraduate gives all fifteen, with the alternative techniques and the reasons for choosing between them, the measurements, and six special dissections — the cardiac conduction system, the spinal cord, the vitreous, the middle and inner ear, the pituitary, and the pelvic organs. Each organ also carries a checklist for use at the table and a set of practice questions with worked explanations.
The organs covered
Chest
HeartMBBS
Cor
The organ where the choice of cut decides what you can still see afterwards. Inflow–outflow opening, short-axis bread-slicing, when each is chosen, and how the coronaries are cut and graded.
Lungs and airwayMBBS
Pulmones
Look for the embolus before you slice, because slicing is what destroys it. Hilar and lateral approaches, perfusion fixation, and how the larynx, trachea and main bronchi are opened.
Neck structuresMBBS
Regio cervicalis
Take the brain out first, or you will make the haemorrhage you then report. The careful anterior removal, and what the posterior approach shows in suspected neck injury.
Cardiac conduction systemMD / PG
Systema conducens cordis
Two rectangles of tissue, and the sinus node is not one you can see. Where the blocks are taken from, how they are oriented, and what the sections are expected to show.
Head
BrainMBBS
Encephalon
Four points on the skull, and each one has a specific way of going wrong. Scalp incision, sawing the vault, detaching the brain, and coronal sectioning of the fixed specimen.
Spinal cordMD / PG
Medulla spinalis
Ten to fifteen minutes with an oscillating saw, and the source says it belongs in every autopsy. Posterior and anterior approaches, and how the cord is fixed before it is cut.
Eye and vitreousMD / PG
Oculus
The needle goes in obliquely, and if it touches the retina the potassium reading is worthless. Vitreous sampling, enucleation, and the plane the globe is opened in.
Middle and inner earMD / PG
Auris media et interna
Look into it whenever there is inflammation inside the skull, even when you are not taking it out. Inspection in situ, and removal of the temporal bone block.
Pituitary glandMD / PG
Hypophysis cerebri
Either take the fossa with it, or go in for the gland alone. The first also opens the sinuses.
Abdomen and pelvis
Liver and biliary tractMBBS
Hepar
The duct work is dissected before the liver comes out, not after. Frontal and horizontal slices, the gallbladder opened over a strainer, and testing patency in the newborn.
Kidneys and uretersMBBS
Renes
Strip the capsule while the vessels are still attached, and the kidney stops slipping out of your hand. The routine incision, and the ureters followed to the bladder.
SpleenMBBS
Lien
Fixative does not get into the pulp, so the slice has to be thin. Frontal or horizontal sections, and washing out the pulp by perfusion.
Gullet, stomach and intestineMBBS
Oesophagus, gaster, intestinum
Take the histology before the specimen goes under the running tap. Where each viscus is opened, and the note on gastric emptying.
PancreasMBBS
Pancreas
One block goes in the cassette, and it comes from the tail. Sections along the duct, and what autolysis has already done before you start.
Bladder and pelvic organsMD / PG
Vesica urinaria et organa pelvis
Fix it full, then take the top off. En bloc removal of the pelvic contents, and the order the organs are opened in.
The source
Every technique, figure and caution was read from Ludwig J, editor. Handbook of Autopsy Practice. 3rd ed. Totowa, New Jersey: Humana Press; 2002 (ISBN 1-58829-169-3), and rewritten. No sentence, table, figure or illustration from that book is reproduced here; it is cited, not republished, and it remains in copyright to the Mayo Foundation for Medical Education and Research. Where the book does not treat something, the tool says so rather than filling the gap from elsewhere, and the chapter is named at the foot of every organ so any statement can be traced back and checked.
What this is not
Not a substitute for supervised training in the autopsy room. Not Indian medicolegal procedure — inquest requisition, the role of the magistrate and preservation of viscera in the Indian pattern are not in the source and are not in this tool. Not a legal authority on any point, and not clinical or forensic advice in any actual case. Not a complete autopsy: the external examination, the primary incisions, opening the cavities, evisceration as a whole and the special-death autopsies are outside its scope.
The interactive version — level selection, the checklists at the table, and the practice questions — needs JavaScript. Text, structure, design and code are licensed CC BY-NC-ND 4.0. Published on Forensic Medicine Workbench. Corrections and permission requests: [email protected].