<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">FMAR</journal-id><journal-title-group><journal-title>Forensic Medicine and Anatomy Research</journal-title></journal-title-group><issn pub-type="epub">2327-4115</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/fmar.2017.53003</article-id><article-id pub-id-type="publisher-id">FMAR-78465</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  A Brief Review on the Principles of Human Cadaver Preservation and Monitoring of Microbial Degradation
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mohammed</surname><given-names>H. Karrar Alsharif</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Muhammad</surname><given-names>Musthafa</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Abubaker</surname><given-names>Y. Elamin</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Elmutasim</surname><given-names>O. Ibnouf</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Khalid</surname><given-names>M. Taha</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mamoun</surname><given-names>A. Alfaki</given-names></name><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Younis</surname><given-names>S. Nour</given-names></name><xref ref-type="aff" rid="aff7"><sup>7</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Khalid</surname><given-names>Hadi M. Aldosari</given-names></name><xref ref-type="aff" rid="aff8"><sup>8</sup></xref></contrib></contrib-group><aff id="aff5"><addr-line>Anatomy Department, Faculty of Medicine, University of Science and Technology, Khartoum, Sudan</addr-line></aff><aff id="aff8"><addr-line>Prince Sattam Bin Abdulaziz University, Al-kharj, KSA</addr-line></aff><aff id="aff7"><addr-line>Department of Pharmaceutical Microbiology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, KSA</addr-line></aff><aff id="aff1"><addr-line>Histology and Embryology Department, College of Medicine, Ondokuz Maiz University, Samsun, Turkey</addr-line></aff><aff id="aff4"><addr-line>Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Omdurman Islamic University, Omdurman, Sudan</addr-line></aff><aff id="aff6"><addr-line>Anatomy Department, Faculty of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, KSA</addr-line></aff><aff id="aff2"><addr-line>Department of Microbiology and Immunology, Faculty of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, KSA</addr-line></aff><aff id="aff3"><addr-line>Emergency Medical Specialtist Department, Al-Ghad International Colleges for Applied Medical Sciences, Al Madinah Al Munawarah, KSA</addr-line></aff><pub-date pub-type="epub"><day>31</day><month>07</month><year>2017</year></pub-date><volume>05</volume><issue>03</issue><fpage>19</fpage><lpage>31</lpage><history><date date-type="received"><day>April</day>	<month>27,</month>	<year>2017</year></date><date date-type="rev-recd"><day>Accepted:</day>	<month>July</month>	<year>28,</year>	</date><date date-type="accepted"><day>July</day>	<month>31,</month>	<year>2017</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Putrefaction and decay of preserved cadaver and body parts is one of the major issues that the faculties of medicines in various third world countries are facing. In this study we focus on the meaning of body preservation, causes of putrefaction and we highlight our personal experiences at the Faculty of Medicine in Prince Sattam bin Abdulaziz University in KSA, in preserving the body cadavers. We studied different physical and chemical methods of preservation of cadavers and body parts at the faculty and their efficiency in preventing bacteria and fungi that cause putrefaction and decay.
 
</p></abstract><kwd-group><kwd>Preservation</kwd><kwd> Mummification</kwd><kwd> Plastination</kwd><kwd> Embalming</kwd><kwd> Putrefaction</kwd><kwd> Bacterial  Isolation</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Meaning of preservation</p><p>It’s the art and science of human body to treat it with chemical components for preservation by preventing or intercepting microorganisms such as bacteria and fungi which are classified as main causes of organic decomposition which lead to putrefaction [<xref ref-type="bibr" rid="scirp.78465-ref1">1</xref>] .</p><p>Embalming is an ancient art established by old Egyptians [<xref ref-type="bibr" rid="scirp.78465-ref2">2</xref>] . It is worth being mentioned here that, this is used in many purposes such as transportation of dead body from place to another, as religious practice in some countries etc.</p><p>In this study we will focus on Embalming for anatomy education. Most of faculties of medicine around the world use the body cadaver for teaching anatomy for medical student and for research, and this type of preservation is called (anatomical preservation) [<xref ref-type="bibr" rid="scirp.78465-ref3">3</xref>] .</p></sec><sec id="s2"><title>2. Types of Body Preservation</title><sec id="s2_1"><title>2.1. Natural Preservation</title><p>This type of preservation occurs by natural factors including freezing and dryness that may occur by dry-heat or dry-cold (<xref ref-type="fig" rid="fig1">Figure 1</xref>) and the soil nature [<xref ref-type="bibr" rid="scirp.78465-ref4">4</xref>] . The body or body parts preserved by this can be called the naturally mummified one.</p></sec><sec id="s2_2"><title>2.2. Mummification</title><p>It can be divided according to the causative agents which cause preservation of dead body. They are:</p><p>A) Natural mummification: This is caused by the Mother Nature which occurs when buried in [<xref ref-type="bibr" rid="scirp.78465-ref5">5</xref>] and climate conditions.</p><p>B) Artificial mummification or true mummification: This is the type of preservation that had been done by Ancient Egyptian civilization for religious concepts (<xref ref-type="fig" rid="fig2">Figure 2</xref>) [<xref ref-type="bibr" rid="scirp.78465-ref6">6</xref>] . According to Greek historian Herodotus there are three types of artificial mummifications and all of them share the same target of interception of decomposition of the dead body [<xref ref-type="bibr" rid="scirp.78465-ref7">7</xref>] .</p><p>Different materials had been used in the mummification include materials that desiccate and dehydrate such as natron salt and vegetable materials and those act as anti-bacterial factors such as Mastic, Lichen, Myrrh, Bitumen, Cassia, Onions, Beeswax, Lichen, Coniferous resin, Henna and Gum Arabic [<xref ref-type="bibr" rid="scirp.78465-ref5">5</xref>] .</p><fig id="fig1"  position="float"><label><xref ref-type="fig" rid="fig1">Figure 1</xref></label><caption><title> 5300 year old Iceman found in Alps Mountains</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x2.png"/></fig><p>Source: http://familypedia.wikia.com/wiki/%C3%96tzi_the Iceman</p><fig id="fig2"  position="float"><label><xref ref-type="fig" rid="fig2">Figure 2</xref></label><caption><title> Ancient Egyptian mummy</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x3.png"/></fig><p>Source: http://news.softpedia.com/news/Scientists-Mummify-Human-Leg-in-Bizarre-and-Twisted-Experiment-482441.shtml#sgal_0</p></sec><sec id="s2_3"><title>2.3. Plastination</title><p>This is a method or technique used for the long term preservation of body or part of body [<xref ref-type="bibr" rid="scirp.78465-ref8">8</xref>] . This technique was established by German scientist Gunther von Hagens in 1977 [<xref ref-type="bibr" rid="scirp.78465-ref9">9</xref>] in laboratory of Heidelberg University [<xref ref-type="bibr" rid="scirp.78465-ref10">10</xref>] . The main advantage of this way of preservation that the specimens were dry, durable, odorless, handleable and storable manner [<xref ref-type="bibr" rid="scirp.78465-ref11">11</xref>] . In the process of plastination the fluids and lipids in biological tissues substitute by curable polymers commonly epoxy, silicone and polyester. As a result of this procedure the specimen gets harden and a natural look [<xref ref-type="bibr" rid="scirp.78465-ref9">9</xref>] and the decomposition which lead to putrefaction of biological tissues is intercepted.</p><p>As previously described many chemicals can be used to replace the fluid and fat this led to provide different techniques of plastination here we will mention some of this techniques.</p><p>a) Silicone plastination</p><p>Silicone plastination is one of most common techniques of plastination which can be used for body, organs, part of organ and slices [<xref ref-type="bibr" rid="scirp.78465-ref8">8</xref>] (<xref ref-type="fig" rid="fig3">Figure 3</xref>). The Plastination techniques depend on vacuum of original body or tissue fluid and replace it by special curable polymer of the standard silicone S-10 [<xref ref-type="bibr" rid="scirp.78465-ref9">9</xref>] . The fixative chemical mostly use is formaldehyde. This technique was invented by Gunther von Hagens [<xref ref-type="bibr" rid="scirp.78465-ref12">12</xref>] .</p><p>Silicone plastination consist of four steps after preparation of specimen and are dehydration, defatting, hardening and formaldehyde embalming or fixation (<xref ref-type="fig" rid="fig3">Figure 3</xref>, <xref ref-type="fig" rid="fig4">Figure 4</xref>).</p><p>b) Epoxy plastination</p><p>This techniques of plastination is usually used for tissue examination especially slices of 2 - 4 mm [<xref ref-type="bibr" rid="scirp.78465-ref13">13</xref>] . The techniques of preservation are similar to previous one and it substitutes of all water and most of lipid with curable resin [<xref ref-type="bibr" rid="scirp.78465-ref14">14</xref>] . The result of epoxy plastination is durable sectional slices looking like magnetic resonance Image and computed tomography so it suitable for studying anatomy at gross or macroscopic to the microscopic level (<xref ref-type="fig" rid="fig5">Figure 5</xref>).</p><fig id="fig3"  position="float"><label><xref ref-type="fig" rid="fig3">Figure 3</xref></label><caption><title> The liver of human cadaver, silicone plastination (Anatomy Lab, Collage of Medicine, Prince Sattam Bin Abdulaziz University)</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x4.png"/></fig><fig id="fig4"  position="float"><label><xref ref-type="fig" rid="fig4">Figure 4</xref></label><caption><title> The brain of human cadaver, silicone plastination (Anatomy Lab, Collage of Medicine, Prince Sattam Bin Abdulaziz University)</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x5.png"/></fig><p>Source: Ottone, N.E., Del Sol M. and Fuentes, R. (2016) Report on a Sheet Plastination Technique Using Commercial Epoxy Resin. International Journal of Morphology, 34, 1039-1043 [<xref ref-type="bibr" rid="scirp.78465-ref15">15</xref>] .</p><fig id="fig5"  position="float"><label><xref ref-type="fig" rid="fig5">Figure 5</xref></label><caption><title> Comparison between computed tomography image (right) and epoxy plastinated specimen (left)</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x6.png"/></fig><p>According to T. Shahar [<xref ref-type="bibr" rid="scirp.78465-ref13">13</xref>] the chemicals which are used in (generic) epoxy plastination technique and Biodur<sup>TM</sup> E12 sheet epoxy plastination technique are the same which include:</p><p>・ Fixatives (if necessary)</p><p>・ Methylene chloride (MeCl) as defatting agents</p><p>・ Acetone</p><p>・ Epoxy resin</p><p>・ Epoxy hardeners to link the epoxy molecules</p><p>・ Epoxy plasticiser</p><p>c) Polyester plastination</p><p>The basic steps in this technique are also the same as described in the earlier procedure. In Polyester plastination the tissue fluids withdrawn and replaced by</p><p>Source: http://www1.zu.edu.eg/plastination/polyester_plastination_1_files/frame.htm</p><fig id="fig6"  position="float"><label><xref ref-type="fig" rid="fig6">Figure 6</xref></label><caption><title> Polyester plastination for semitransparent brain slices</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x7.png"/></fig><p>curable Polyester resin [<xref ref-type="bibr" rid="scirp.78465-ref16">16</xref>] such as P40 as described by von Hagens [<xref ref-type="bibr" rid="scirp.78465-ref17">17</xref>] , or P35 resin that has been used by von Hagens or the new comer P45 resin as described by Gao, H [<xref ref-type="bibr" rid="scirp.78465-ref18">18</xref>] [<xref ref-type="bibr" rid="scirp.78465-ref19">19</xref>] . This method is suitable to study the anatomical formation of 4 - 8 mm slices of nervous tissue [<xref ref-type="bibr" rid="scirp.78465-ref16">16</xref>] (<xref ref-type="fig" rid="fig6">Figure 6</xref>). The basic steps in polyester plastination technique are preparation of specimen, slicing and dehydration. The chemicals used according to Sargon, M.F. [<xref ref-type="bibr" rid="scirp.78465-ref8">8</xref>] include the following:</p><p>・ fixatives (if necessary)</p><p>・ acetone</p><p>・ methylene chloride (if necessary)</p><p>・ polyester resin.</p></sec><sec id="s2_4"><title>2.4. Embalming</title><p>The term of Embalming derived from Latin origin and it define as treatment of body cadavers with special chemicals so as prevent decay or putrefaction, it was an ancient culture and nowadays in modern culture it become substantial science and art due to social and science reason because the preserved body cadaver considered as an ideal teaching tool for anatomy and other branches medical science such as surgery, obstetrics, pathology and radiology [<xref ref-type="bibr" rid="scirp.78465-ref4">4</xref>] [<xref ref-type="bibr" rid="scirp.78465-ref20">20</xref>] .</p><p>a) Embalming in the ancient cultures</p><p>Many ancient cultures including Egyptian culture practiced embalming as they believed that decayed dead of the body would preclude it from life after death [<xref ref-type="bibr" rid="scirp.78465-ref21">21</xref>] . The basic steps of ancient embalming are:</p><p>1) Washing surface and body cavity with palm wine.</p><p>2) Removal of brain and internal organs (viscera) and keep it in jars except the heart.</p><p>3) Left the internal organ to dry.</p><p>4) Cover body with natron salt to dry.</p><p>5) After 40 days the body is wash with wine and spices.</p><p>6) Return back the organs inside the body.</p><p>7) Wrapped the body with linen.</p><p>8) Place the body inside coffin.</p><p>b) Modern embalming</p><p>As the relevance of body cadavers in anatomical studies cannot be ruled out, the embalming for preservation became more important. The process of embalming consists of four steps can be summarized as the following:</p><p>・ Arterial embalming: it is the injection of embalming fluid through the blood vessels usually the common carotid artery. This is to replace the body fluid by embalming solution.</p><p>・ Cavity embalming: this refers to substitute gas and fluid in the organ and inner side of the body with embalming fluid using a trocar.</p><p>・ Hypodermic embalming: this is a complementary step to ensure that concentrated embalming fluid reach all parts of the body, especially to those sites of body where the arterial fluids might not reached. This is done by using hypodermic needle and is a case-by-case basis step.</p><p>・ Surface embalming and washing: this is a (as needed step) remedy or treatment in damaged area in the surface which may occur due to a lot of causes such as skin diseases, cancer, decomposition or other epidermal injury.</p><p>Erich Brenner [<xref ref-type="bibr" rid="scirp.78465-ref4">4</xref>] in his great review article mention and compare between different types of modern anatomical embalming techniques in term of long-term storage, advantages and disadvantages and Possibilities of usage in anatomical teaching (<xref ref-type="table" rid="table1">Table 1</xref>).</p></sec><sec id="s2_5"><title>2.5. Embalming Chemicals</title><p>The chemical components of embalming fluid used in modern embalming are variety which includes sterilization and disinfectant agents, preservatives, modifying agents (buffers, anticoagulants, and wetting agents) and dyes [<xref ref-type="bibr" rid="scirp.78465-ref4">4</xref>] .</p></sec></sec><sec id="s3"><title>3. Meaning of Body Putrefaction</title><p>The biodegradation is the breakdown of complex organic materials into simpler chemicals by biochemical process [<xref ref-type="bibr" rid="scirp.78465-ref22">22</xref>] . Actually, the oxidative breakdown of synthetic or natural substances is taken place by microbial activity [<xref ref-type="bibr" rid="scirp.78465-ref23">23</xref>] . Biodegradation of body is the final process of the biological destruction of body and is commonly termed as decomposition or putrefaction [<xref ref-type="bibr" rid="scirp.78465-ref24">24</xref>] .</p><p>The putrefaction is the destruction of the soft tissues of the body and is it done by two different groups of organisms, i.e., the scavengers and the true decomposers like (bacteria fungi protozoa) [<xref ref-type="bibr" rid="scirp.78465-ref25">25</xref>] , and both of them are complimentary to each other in function.</p><p>There are two types of scavengers: invertebrates (e.g. flies, ants, mites, dermestids cockroaches etc.) and vertebrates (e.g. fish reptiles, big birds like vultures or mammals like jackals, rodents etc.) [<xref ref-type="bibr" rid="scirp.78465-ref26">26</xref>] .</p><p>After the death of the human being, foul odour from the decomposing body attracts the houseflies and blow flies [<xref ref-type="bibr" rid="scirp.78465-ref27">27</xref>] , and usually these flies arrive the dead body within 2 - 4 hours and put their egg in natural orifice or damaged skin [<xref ref-type="bibr" rid="scirp.78465-ref27">27</xref>] .</p><p>Then the eggs hatch and the flies come out. Maggots secrets protolytic enzyme</p><table-wrap id="table1" ><label><xref ref-type="table" rid="table1">Table 1</xref></label><caption><title> Comparative table of different modern anatomical embalming techniques</title></caption><table><tbody><thead><tr><th align="center" valign="middle" >Teaching (Dissection)</th><th align="center" valign="middle" >Long Term Storage</th><th align="center" valign="middle" >Disadvantage</th><th align="center" valign="middle" >Advantage</th><th align="center" valign="middle" >Technique</th></tr></thead><tr><td align="center" valign="middle" >Not tested</td><td align="center" valign="middle" >Extremely well when the coffin sealed</td><td align="center" valign="middle" >Toxic</td><td align="center" valign="middle" >Long term storage</td><td align="center" valign="middle" >Salafia (c. 1927-1933)</td></tr><tr><td align="center" valign="middle" >Not applicable</td><td align="center" valign="middle" >Not applicable</td><td align="center" valign="middle" >Only for isolated specimens</td><td align="center" valign="middle" >Good preservation of colour and form</td><td align="center" valign="middle" >Kaiserling (pulvertaft, 1950)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Easy storage</td><td align="center" valign="middle" >Jores (1896, 1913)</td></tr><tr><td align="center" valign="middle" >Highly satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Medium brown colour</td><td align="center" valign="middle" >Very active as fungicidal agent, soft and the plastic cheap</td><td align="center" valign="middle" >Woodburne &amp; Lawrence (1952)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >Possible</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Good preservation of intestines doesn’t affect the the dissector’s skin, odourless, objects sty smooth and elastic, colour-preserving</td><td align="center" valign="middle" >Peters (1956)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Soft and flexible less exsiccation</td><td align="center" valign="middle" >Erskine (1961)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Successful for 2 years</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Decrease rigidity increased bactercidity and fungicidity, less Browning</td><td align="center" valign="middle" >Richins et al. (1963)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Dayton et al. (1965)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Beck (1966)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Cheap, odourless</td><td align="center" valign="middle" >Tutsch (1975)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No adequate fixation of brains</td><td align="center" valign="middle" >Moderate degree of movability and adequate degree of hardness for dissection</td><td align="center" valign="middle" >Bradbury &amp; Hoshino (1978)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Almost unlimited, when vacuum packed</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Increase fungicidity, cheap</td><td align="center" valign="middle" >Platzer et al. (1978)</td></tr><tr><td align="center" valign="middle" >Facilitates micro-dissection</td><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Soft preservation, obviates excessive noxious fumes</td><td align="center" valign="middle" >Logan (1983)</td></tr><tr><td align="center" valign="middle" >“Suitable”</td><td align="center" valign="middle" >Up to 10 years</td><td align="center" valign="middle" >Slight odour, headache, drowsiness, mild eye, nose and throat irritations</td><td align="center" valign="middle" >Soft and flexible</td><td align="center" valign="middle" >Frolich et al. (1984)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Fluid accumulation</td><td align="center" valign="middle" >Smooth, colour-preserving</td><td align="center" valign="middle" >Frewein et al. (1987)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >“Well fixed”</td><td align="center" valign="middle" >Ikeda et al (1988)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >Proved up to 2.5 years</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Formaldehyde vapour levels below COSHH limits, improved tissue preservation, more nature coloration</td><td align="center" valign="middle" >O’sullivan&amp; Mitchell (1993)</td></tr><tr><td align="center" valign="middle" >Satisfactory up to 6 months</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Grey hue of skin</td><td align="center" valign="middle" >Less toxic</td><td align="center" valign="middle" >Macdonald &amp; MacGregor (1997)</td></tr><tr><td align="center" valign="middle" >Satisfactory</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Excellent preservative properties, minimal structural distoration, tissue supple, little desiccation, natural colours</td><td align="center" valign="middle" >Coleman &amp; Kogan (1998)</td></tr><tr><td align="center" valign="middle" >High acceptance</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Expensive, disintegration of muscular tissue, limited for dissection</td><td align="center" valign="middle" >High colour preservation, smooth and flexible</td><td align="center" valign="middle" >Thiel (1992,2002)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Powers (2003)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data Available</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >High mould preventiong</td><td align="center" valign="middle" >Mills (2010)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >When waxed, possible</td><td align="center" valign="middle" >Hardening outside the tank, &gt;2 days for re-softening</td><td align="center" valign="middle" >Not structural distortion, not colour changes</td><td align="center" valign="middle" >Al-Hayani et al. (2011)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Up to 1.5 years</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Natueal appearance, odourless</td><td align="center" valign="middle" >Anichkov et al. (2011)</td></tr><tr><td align="center" valign="middle" >Limited usability</td><td align="center" valign="middle" >Up to 1year</td><td align="center" valign="middle" >Yellowish coloration, corrosion, disintegration of abdominal organs</td><td align="center" valign="middle" >Neutral smell</td><td align="center" valign="middle" >Janczyk et al. (2011a)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Up to 3 years</td><td align="center" valign="middle" >Expensive</td><td align="center" valign="middle" >Flexible tissues, aesthetic appearance, less toxic</td><td align="center" valign="middle" >Hammer et al. (2012)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Up to 2 years</td><td align="center" valign="middle" ></td><td align="center" valign="middle" >Less toxic, good preservative properties, low volatility</td><td align="center" valign="middle" >Shi et al. (2012)</td></tr><tr><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >No data available (good for short term preservation ≤ 6 months)</td><td align="center" valign="middle" >No data available</td><td align="center" valign="middle" >Good coloration and flexibility</td><td align="center" valign="middle" >Goyri-O’Neill et al. (2013)</td></tr></tbody></table></table-wrap><p>softening the skin and make the way easy into interior of the body [<xref ref-type="bibr" rid="scirp.78465-ref28">28</xref>] .</p><p>The bacteria are the principal agents which ultimately bring about the final reduction of the biological refuse [<xref ref-type="bibr" rid="scirp.78465-ref29">29</xref>] .</p><p>Systemic study of the cadaveric bacteriology was undertaken by Burn [<xref ref-type="bibr" rid="scirp.78465-ref30">30</xref>] and he found two groups of bacteria on cadavers. The first group includes anaerobic spore-bearing bacilli (e.g. CI. Welhii), coliforms, micrococci, diptheroids and proteus bacteria which are normally present in the respiratory or. Intestinal tracts and they penetrate the mucosa and rapidly invade the tissue shortly after death. The second group of bacteria includes variety pathogenic and non-pathogenic strains [<xref ref-type="bibr" rid="scirp.78465-ref31">31</xref>] . The marked increase in hydrogen ion concentration and the rapid loss of oxygen in the tissue after death favours the growth of anaerobic organisms. The blood is the most natural nutrient medium for microbial growth [<xref ref-type="bibr" rid="scirp.78465-ref30">30</xref>] .</p><p>The first visible sign of putrefaction is a greenish discoloration of the skin due to the formation of sulfhaemoglobin in settled blood. The process progresses into distension of tissues due to the formation of various gases (hydrogen sulfide, carbon dioxide, methane, ammonia, sulfur dioxide and hydrogen), especially in the bowels [<xref ref-type="bibr" rid="scirp.78465-ref32">32</xref>] . During putrefaction a number of gases are formed in the tissues e.g. hydrogen sulphide, marsh, methane, carbon-dioxide, ammonia and hydrogen phosphide [<xref ref-type="bibr" rid="scirp.78465-ref33">33</xref>] [<xref ref-type="bibr" rid="scirp.78465-ref34">34</xref>] .</p><p>There are other factors which affect the putrefaction like the weather. Putrefaction is increased in warm rather than in cold [<xref ref-type="bibr" rid="scirp.78465-ref35">35</xref>] .</p><p>Some studies [<xref ref-type="bibr" rid="scirp.78465-ref36">36</xref>] [<xref ref-type="bibr" rid="scirp.78465-ref37">37</xref>] [<xref ref-type="bibr" rid="scirp.78465-ref38">38</xref>] have shown the presence of microorganism including pathogenic bacteria in cadavers which are preserved using chemicals or other physical methods. So in this study we analyze the cadavers and body parts preserved using embalming and plastination techniques which carried out at department of anatomy in Faculty of Medicine in Salman Bin Abdulaziz University (KSA). The evaluation of preservation depends on two factors one of which is the minimal tissues and body structural distortion and the second is the microbiological properties which is performed by standard sampling procedures as mentioned somewhere else in this article.</p><p>- Usually the unused cadavers stored in refrigerator at (0˚C - 1˚C).</p><p>- Regarding the embalmed cadavers stored in stainless steel tanks with 10% formaldehyde diluted in water, all the cadavers were injected with embalming fluid.</p><p>The evaluation of preservation factors in department of anatomy in Faculty of Medicine in Salman Bin Abdulaziz University will take place as the following:</p><sec id="s3_1"><title>3.1. Evaluation of Physical Characteristics of Body Cadavers after Embalming</title><p>The assessment of physical characteristics according to Benkhadra [<xref ref-type="bibr" rid="scirp.78465-ref39">39</xref>] depends on the softness and flexibility of body cadaver, and actually we get a positive result because the body cadavers maintained its softness and flexibility, that may be explained by the large amount of muscles proteins fragmentation [<xref ref-type="bibr" rid="scirp.78465-ref39">39</xref>] . The second part of the evaluation depends on the biomechanical testing which can be considered as acceptable in our case, taking the fact in consideration that keeping cadaver in formalin will cause a 50% stenography in energy absorption and raise the rate of bone crispness [<xref ref-type="bibr" rid="scirp.78465-ref40">40</xref>] and also the mechanical integrity will decrease after embalming due to bone demineralization [<xref ref-type="bibr" rid="scirp.78465-ref41">41</xref>] .</p></sec><sec id="s3_2"><title>3.2. Sampling for Microbes</title><p>a) Sampling from cadaver for possible bacterial and fungal population</p><p>The samples were collected using standard swabbing procedures from different body parts of the 1) cadaver stored in 10% formalin, 2) cadaver stored in refrigerator at (0˚C - 1˚C), and 3) plastinated body parts stored at room temperature.</p><p>The swabs were taken from oral cavities, nasal cavities, upper limbs, abdomen, genital area and axilla (<xref ref-type="fig" rid="fig7">Figure 7</xref>, <xref ref-type="fig" rid="fig8">Figure 8</xref>). The swabs were aseptically plated onto Nutrient Agar (NA, CM0003, Oxoid Ltd., Basingstoke, Hampshire, England) plates and Muller Hinton Agar (MHA, CM0337, Oxoid Ltd., Basingstoke, Hampshire, England) plates. The plates were incubated at 37˚C for 48 hours (<xref ref-type="fig" rid="fig9">Figure 9</xref>). Also, the swabs were plated on Sabourad’s Dextrose Agar (SDA, CM0041, Oxoid Ltd., Basingstoke, Hampshire, England) plates and incubated at room temperature for up to 7 days.</p><p>b) Sampling for airborne bacteria/fungi</p><p>Sampling for possible airborne bacterial and fungal population was done in the respective rooms/labs where the specimens were kept. This is done by standard non-volumetric air sampling method. The nutrient agar and Muller Hinton agar plates were incubated at 370˚C for 48 hours and the Sabourad’s Dextrose <sup> </sup></p><fig-group id="fig7"><label><xref ref-type="fig" rid="fig7">Figure 7</xref></label><caption><title> Different sites of sampling on plastinated body parts.</title></caption><fig id ="fig7_1"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x10.png"/></fig><fig id ="fig7_2"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x9.png"/></fig><fig id ="fig7_3"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x8.png"/></fig></fig-group><fig id="fig8"  position="float"><label><xref ref-type="fig" rid="fig8">Figure 8</xref></label><caption><title> Swabs sampled from different sites</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x11.png"/></fig><fig id="fig9"  position="float"><label><xref ref-type="fig" rid="fig9">Figure 9</xref></label><caption><title> Incubation of plates inoculated with samples</title></caption><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x12.png"/></fig><p>Agar plates were incubated at room temperature for 7 days.</p></sec></sec><sec id="s4"><title>4. Identification of the Bacteria/Fungi</title><p>Bacterial isolates were subjected to various morphological and biochemical characterization tests to determine the identity of the bacterial population using standard method [<xref ref-type="bibr" rid="scirp.78465-ref42">42</xref>] .</p></sec><sec id="s5"><title>5. Results and Discussion</title><p>Neither Nutrient Agar plates nor Muller Hinton Agar plates incubated with samples from different sites of plastination, refrigerated and preserved in forma-</p><fig-group id="fig10"><label><xref ref-type="fig" rid="fig1">Figure 1</xref>0</label><caption><title> Incubated plates of different samples showing no growth.</title></caption><fig id ="fig10_1"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x15.png"/></fig><fig id ="fig10_2"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x14.png"/></fig><fig id ="fig10_3"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x13.png"/></fig><fig id ="fig10_4"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x17.png"/></fig><fig id ="fig10_5"><label></label><graphic mimetype="image"   position="float"  xlink:type="simple"  xlink:href="http://html.scirp.org/file/1-2790113x16.png"/></fig></fig-group><p>lin cadavers/body parts described elsewhere in this article showed any growth of bacteria (<xref ref-type="fig" rid="fig1">Figure 1</xref>0).</p><p>The same was the fate of the Sabourad’s Dextrose Agar (SDA) plates which were incubated for possible fungal growth from the cadavers and body parts. This, in turn, proves the higher efficiency of embalming and preservation methods performed at the faculty of medicine, Prince Sattam bin Abdulaziz University. The Nutrient Agar plates which were subjected for airborne bacterial sampling in the Anatomy laboratory where the plastination samples are kept showed the presence of Staphylococcus and Lactobacillus species. At the same time the plates sampled the air of the mortuary shown no growth of bacteria which justifies the intense fumigation effect and the intense odor of formalin which is used as preservative for the cadaver.</p></sec><sec id="s6"><title>Cite this paper</title><p>Alsharif, M.H.K., Musthafa, M., Elamin, A.Y., Ibnouf, E.O., Taha, K.M., Alfaki, M.A., Nour, Y.S. and Aldosari, K.H.M. (2017) A Brief Review on the Principles of Human Cadaver Preservation and Monitoring of Microbial Degradation. Forensic Medicine and Anatomy Research, 5, 19-31. https://doi.org/10.4236/fmar.2017.53003</p></sec></body><back><ref-list><title>References</title><ref id="scirp.78465-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Frederick, L.G. and Strub, C.U. (1989) The Principles and Practice of Embalming. 5th Edition, Professional Training Skills Inc. &amp; Robertine Frederick, Dallas, TX, 1-487.</mixed-citation></ref><ref id="scirp.78465-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">Batra, A.P.S., Khurana, B.S. and Kaur, N. (2010) Embalming and Other Methods of Dead Body Preservation. International Journal of Medical Toxicology &amp; Legal Medicine, 12, 15-19.</mixed-citation></ref><ref id="scirp.78465-ref3"><label>3</label><mixed-citation publication-type="other" xlink:type="simple">Ikeda, A., Fujimoto, K., Yoshii, I., Matsumoto, S., Nishitani, K. and Ikeda, K. 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