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Johan Duflou,
F.R.C.P.A.; Bradley McNamara,
Certificate in Mortuary Practice; and
Robert Cluney,
Certificate in Mortuary Practice
A Safer Method for Body Restoration
Following Autopsy
ABSTRACT: Restoration of autopsy incisions can result in inadvertent needle stick injury to the prosector, which can be difficult to prevent
even with the use of personal protective equipment such as Kevlar cut resistant gloves. We present a new technique for closure of autopsy inci-
sions using a commonly available commercial hardware tool, a hole punch with a lever enhanced action, combined with blunt probe sewing,
which results in an esthetic and leak-proof means of restoring cadavers. This technique is especially useful in cases which may pose blood-
borne infection risks to the prosector.
KEYWORDS: forensic science, forensic pathology, autopsy techniques, infectious diseases, workplace hazards, needlestick injury
The autopsy mortuary and the practice of autopsy pathology
expose medical and technical personnel to multiple hazards,
including exposure to infectious diseases, poisons, mechanical
injury from heavy weights and falls, cuts, and needlestick inju-
ries (1). Standard precautions, including the use of personal pro-
tective equipment (PPE) are generally highly effective in
preventing transmission of infectious diseases in this setting.
Routine use of Kevlar-coated puncture-resistant gloves has
decreased the incidence of sharps injuries in the autopsy work-
place, but these safety devices have not provided good protec-
tion against needlestick injury (2).
The autopsy can be modified so that the use of sharps is mini-
mized and most dissection is done using safer equipment such
as scissors and blunt dissection techniques. However, the restora-
tion of cadavers following autopsy is performed using a variety
of needles and string, using an under-stitching technique to pro-
duce an acceptable esthetic outcome with the added advantage
of minimizing leakage of postmortem fluids from the body (3).
It has been our experience that the needles used for the restora-
tion of these incisions are able to penetrate puncture-resistant
gloves, potentially exposing the operator to blood-borne trans-
missible diseases.
The Work Health and Safety Act in New South Wales,
Australia, places a duty of care on all personnel to take reason-
ably practicable measures to eliminate risks to health and safety
in the workplace, and if not practicable to eliminate those risks
to health and safety, to minimize those risks as reasonably prac-
ticable (4). Historically, it has been a work practice at the
Department of Forensic Medicine to serologically screen all
autopsy cases for HIV infection and to screen those cases with
known risk factors for hepatitis C infection. In those cases which
were found to be HIV or hepatitis C antibody positive, autopsy
incisions were not restored, thereby minimizing the risk of nee-
dlestick injury during the process of restoration. This policy
caused distress to relatives, because many had wanted to view
the deceased after autopsy, and this wish could not be accommo-
dated as a result of nonrestoration.
Prior alternative, non-needle methods for closing autopsy inci-
sions had been attempted, including stapling, gluing and taping,
but these had all failed because of technical difficulty, a poor
esthetic result or difficulty in maintaining closure of the inci-
sions. The most promising tool used during these investigations
was a leather punch to produce small holes in the skin which
could then be threaded, shoelace-like, to close the body, but
FIG. 1Hole punch tool in action during restoration of autopsy incisions.
Department of Forensic Medicine Sydney, PO Box 90, Glebe, NSW
2037, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW 2006,
Received 1 Aug. 2012; accepted 1 Dec. 2012.
224 2013 American Academy of Forensic Sciences
J Forensic Sci, January 2014, Vol. 59, No. 1
doi: 10.1111/1556-4029.12273
Available online at: onlinelibrary.wiley.com
repeated use of this tool rapidly led to a repetitive strain injury
(RSI) in the wrist of the operator.
This short report details the use of a commonly available
cheap hardware tool, which makes multiple small holes in the
body with minimal wrist force application. The Malco HP18PR
Hole Punch (Malco Products Inc, Annandale, MN) is a tool,
which is generally used to make 1/8 holes in sheet metal up to
18 gauge (c. 1.2 mm) thickness using a punch and die system.
The use of levers increases mechanical advantage by 8 to 1, and
the tool is lightweight, with a resultant low risk of repetitive
strain wrist injury. The resultant perforations in the skin are
readily penetrated using a threaded blunt-ended probe, allowing
a standard autopsy sewing technique (Fig. 1). The esthetic and
leak-proof characteristics of the sewing are practically indistin-
guishable from standard autopsy restoration techniques using
a sharp point needle (Fig. 2). Although this hole punch restora-
tion technique takes about twice as long as standard needle
based restoration techniques, it has been well received by
autopsy technical staff who are responsible for restoration of
autopsy incisions.
Given that use of this tool in conjunction with a blunt-ended
probe to restore infectious bodies effectively eliminates the risk
of needlestick injury during restoration, we recommend the use
of this method of closure of autopsy incisions in any cases
where there is an identified risk of transmission of infectious dis-
ease through needlestick injury at autopsy.
1. Nolte KB, Taylor DG, Richmond JY. Biosafety considerations for
autopsy. Am J Forens Med Pathol 2002;23:10722.
2. Burton JL. The safe and healthy autopsy. In: Burton JL, Rutty GN,
editors. The hospital autopsy, 3rd edn. London, U.K.: Hodder Arnold,
3. Donlon S, Rutty GN. Reconstruction of the body. In: Burton JL, Rutty
GN, editors. The hospital autopsy, 3rd edn. London, U.K.: Hodder
Arnold, 2010;30814.
4. Work Health and Safety Act 2011 (New South Wales, Australia); http://
8828-f33d06042cb9. (accessed September 6, 2013).
Additional information and reprint requests:
Johan Duflou, F.R.C.P.A.
Department of Forensic Medicine Sydney
PO Box 90
Glebe, NSW 2037
E-mail: jo.duflou@sswahs.nsw.gov.au
FIG. 2Completed restoration of main trunk incision following hole
punch restoration technique.