GROSS ANATOMY DISSECTION COURSE:

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GROSS ANATOMY DISSECTION COURSE
ACB 725 Structural Basis for Medical Practice
NO SURGEON LEFT BEHIND PROGRAM -
CARDIOLOGIST, OB, ENT, ORTHOPEDIST, NEUROSURGEON,
EMERGENCY MED, etc.
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GOAL OF COURSE
1. PROVIDE OPPORTUNITY FOR MEDICAL STUDENTS TO
LEARN DISSECTION TECHNIQUES 2. REVIEW GROSS
ANATOMY/THREE DIMENSIONAL STRUCTURE OF BODY
HUMAN ANATOMY IMAGING AND RADIOLOGY
CELL AND MOLECULAR BIOLOGY
NOTE MOST MED SCHOOLS HAVE DISSECTION AS
INTEGRAL PART OF MEDICAL EDUCATION
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OUTLINE OF LECTURE
I. GENERAL ORGANIZATION OF COURSE II. LAB
ORIENTATION III. DISSECTION INSTRUMENTS AND
TECHNIQUES IV. SPECIFIC INSTRUCTIONS TO START
DISSECTIONS V. AFTER LECTURE - GO TO LAB GET
KEYS IF NEEDED START DISSECTION
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FACULTY
DR. CASEY HOLLIDAY, ASST. PROFESSOR
DR. SASHA ZILL, PROFESSOR
office MEB 213 phone [phone] email hollidayc_at_
marshall.edu
office MEB 216 phone [phone] email
sensillum_at_aol.com university zill_at_marshall.edu
IN LAB EVERY DAY 1 PM - 5 PM (EXCEPT JUNE 21, 22
DENTAL SURGERY)
IN LAB BLOCK 1 WEEKS 2,3 BLOCK 2 WEEKS 1,2
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SUPPORT STAFF
Mark Ratliff Laboratory Instructor Office MEB
214 Telephone [phone] ratliffm_at_marshall.edu
M. Aslam Chaudhry Laboratory Associate Office
MEB 219 Telephone [phone] chaudhry_at_marshall.edu
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SECRETARY OF DEPARTMENT OF ANATOMY AND PATHOLOGY
Karen H. Lucas Administrative Secretary
Senior Office MEB 217 Telephone
696-7382 lucaskh_at_marshall.edu
WHEN IN DOUBT, ASK KAREN
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HELP IN DISSECTION IN LAB
BRIDGET KELLER, ANATOMY GRAD STUDENT PH. D.
CANDIDATE
DR. SHABBIR MATCHESWALLA WEEK 1
(PASSED HER COMPREHENSIVE EXAMS JUNE 7)
(MS IV STUDENT GRADUATED MAY 2007)
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CLINICAL PRESENTATIONS/DEMONSTRATIONS
DR. ANDREW MARCUS ORTHOPEDICS WEEK 2
DR. CHARLES GIANGARRA ORTHOPEDICS WEEK 1
CYNTHIA DAVIS MSIV CLASS 2008 SUTURING
DR. BONNIE BEAVER DEPT. SURGERY WEEK 2
EMILY QUINN JASON SNYDER JASON TUCKER DWIGHT
SAULEY JILL RUSHTON
ELBOW SURGERY
ABDOMINAL SURGERY
SHOULDER SURGERY
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CLINICAL PRESENTATIONS/DEMONSTRATIONS
DR. ROBERT DAY ORTHOPEDICS WEEK 2
DR. DOMINIQUE WONG EMERGENCY MED WEEK 3
DR. MITCH CHARLES EMERGENCY MED WEEK 3
KARA KIMBERLY MS I BLOCK 2
ACETABULAR FRACTURE
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COURSE REQUIREMENTS AND GRADING
ONLY REQUIREMENTS 1) DISSECT ONE REGION, 2)
(ATTEND CLINICAL LECTURES/PRESENTATIONS) INSTRUCT
IONS FOR DISSECTION FOLLOW GRANT'S DISSECTOR
13TH EDITION FOR THAT REGION (MODIFIED BY
INSTRUCTIONS) LIST OF STRUCTURES TO FIND NOT
REQUIRED TO FIND ALL, JUST AS MANY AS
POSSIBLE GRADING ASSESSMENT SHOW DR. ZILL OR
OTHER INSTRUCTOR COMPLETED DISSECTION GRADE
PASS/FAIL
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OPTIONAL GENERATE A PROSECTION FOR GROSS ANATOMY
AND EMBRYOLOGY COURSE
1) MAKE A CONTRIBUTION TO MEDICAL EDUCATION 2)
MANY PROSECTIONS CAN BE GENERATED IN NORMAL
SEQUENCE OF DISSECTION SOME LUCK INVOLVED
ANATOMICAL VARIABILITY MEANS SOME STRUCTURES MAY
OR MAY NOT BE PRESENT OR WELL DEVELOPED I WILL
HAND OUT DIAGRAMS/FIGURES FROM ATLAS FOR
PROSECTIONS THAT ARE NEEDED 3) OTHER
PROSECTIONS ARE GENERATED BY SPECIFIC
DISSECTIONS 4) ADDITIONAL DISSECTIONS AVAILABLE
AFTER COMPLETING FIRST REGION (SEE ME IF YOU WANT
TO CHANGE REGIONS NOW)
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SCHEDULE DISSECTION IN LAB, CLINICAL LECTURES
FEW FORMAL LECTURES - not give software review
sessions in class at the start of the course, as
people seem to need time to recover from last
semester. - instead, orient you to software and
I will do review sessions in lab CLINICAL
LECTURES/DEMONSTRATIONS - REALLY INTERESTING -
already in lab Kara Kimberly did carotid
endarterectomy incision. Dr. Bonnie Beaver did
appendectomy incision dissection presentation on
layers of abdominal wall, spleen.
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SCHEDULE
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SOFTWARE
1) RECOMMEND YOU VIEW ACLAND DVD SERIES DISK ON
REGION YOU ARE DISSECTING
1- Regional Anatomy 2- 6 disks 3- Each disk
plays like a movie 4- Advantage very good
dissections of living tissues and review
of structures 5- Disdavantage - slow each
region takes about 2-3 hours
3 COPIES ON COMPUTERS IN GROSS LAB 2 COPIES
CIRCULATE SEE ELIZABETH DUKE
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SOFTWARE
1 - GOOD 3D MODELS AND DESCRIPTIONS 2-
SELF-PACED 3- NO SEQUENCE, NEED TO
SELF-ORGANIZE 4- ONE COPY IN GROSS LAB
2) OTHER PRIMAL SOFTWARE 3D SERIES
3) WEBSITE http//medix.marshall.edu/zill/zill_u
seful_linksf.htm
1- Assembled Anatomy links many good 2- Check
out University of Michigan site for review
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II. LAB ORIENTATION
SPECIMENS IN TRAYS LIKE PROSECTIONS IN GROSS
COURSE CURRENTLY IN PILLOW CASES STORE UNDER
TOWELS WET WITH PHENOL SOLUTION KEEP
SPECIMENS MOIST
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TABLE ASSIGNMENTS YOUR NAME AND SPECIMEN NUMBER O
N TABLE
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RULES OF STATE ANATOMICAL BOARD APPLY TO
THIS COURSE
1- You signed these rules at the start of the
Gross Anatomy and Embryology course. 2- All
specimens and cadavers treated with respect Go
to memorial service if you get a chance can meet
hundreds of family members of donors this is an
important way in which people give to society.
3- No unauthorized photos taken of specimens
no specimens or parts removed from lab under any
circumstance.
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NO VISITORS ALLOWED IN LAB
NO UNAUTHORIZED PERSONS ARE PERMITTED IN THE
GROSS ANATOMY LABORATORY. Any potential
visitors to the gross anatomy laboratory MUST be
cleared in advance and in writing by Dr. Zill.
Only persons with some health care background and
a legitimate reason for being in the laboratory
will be considered for granting access. Requests
for permission for entry to the laboratory must
be made in writing to Dr. Zill. If an
unauthorized person enters the laboratory, ask
them to leave and notify one of the instructors.
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SUPPLIES AND FLUID
1 - TOOLS - each of you get a tool kit please
wash tools regularly 2- LAB COATS - find one
that fits you they are hanging on pegs along
wall of lab 3- GLOVES - in box on island in
center of lab 4- FLUID - in bottles like Gross
course replenish from carboys near sink or from
storage tank 5- MASKS - available from Mark
Ratliff 6- SAWS, BLOCKS, CHISELS - all found in
drawers on island in center of lab
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DISPOSING REMAINS AND PARTS
1 - WHITE PLASTIC TISSUE BUCKETS - on each table
put tissue into them as you are working dispose
of skin as you remove it 2- TISSUE DISPOSAL -
three white covered receptacles with red liners
in lab are for HUMAN REMAINS ONLY place tissues
in these receptacle when plastic bucket is full
and when you are done at the end of the day
(these remains are cremated) 3- PAPER AND TRASH
DISPOSAL - put in regular trash cans not
in Tissue Disposal receptacles 4- SCALPEL BLADE
DISPOSAL - there are boxes on main island in lab
and plastic containers for sharp objects please
do not put scalpel blades in trash
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SPILLING FLUID AND EXCESS FLUID
1- IF FLUID SPILLS, PLEASE CLEAN IT UP
IMMEDIATELY - The floor is linoleum and becomes
very slippery clean up small spills with paper
towels (dispensers on wall) clean up larger
spills with sponge mop (next to Mark Ratliff's
office) 2- DRAIN EXCESS FLUID - draining can be
done with suction syringes (Turkey basters)
dispose of small amounts of fluid in sink but
dilute by running water from tap
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PLEASE KEEP SPECIMENS MOIST!
1- Phenol replaces formaldehyde so less
irritating 2- Fluid containing phenol evaporates
rapidly (whole specimen can dry up in a few
hours) 3- Keep specimens moist and store under
wet towels 4- If you are going away for a day or
two, ask someone to wet down your specimen for
you 5- If you are going away for more than two
days, put specimen back in pillowcase and store
in Tank marked BLOCK 1 (at end of room)
CHECK SPECIMENS EVERY HOUR AND WET DOWN IF LOOK A
LITTLE DRY THEY WILL DRY OUT VERY RAPIDLY
PARTICULARLY IF USING A LAMP.
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IF YOU CUT YOURSELF OR ARE INJURED
1- FIRST AID KIT - this is in top drawer of
island in middle of lab wash out small cuts and
cover with band aid DO NOT LEAVE CUTS
UNTREATED 2- LARGE CUTS, FALLS OR INJURIES - GO
TO VA EMERGENCY ROOM IMMEDIATELY
HEADACHES OR IRRITATION DUE TO FIXATIVE
1- TAKE PERIODIC BREAKS AND GET FRESH AIR -
oxygen is essential to brain function 2- REMOVAL
OF SKIN OF CADAVER OR OPENING CAVITIES PRODUCES
LARGEST CONCENTRATION OF FUMES AND ODORS - use a
mask or take a break usually much less by next
day can also soak overnight in storage
container 3- IF SMELL IS REALLY UNBEARABLE,
NOTIFY INSTRUCTOR
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PREGNANCY
1- If you become pregnant, you MUST inform your
obstetrician of your situation with respect to
the gross anatomy laboratory 2- Let Dr. Zill
know I recommend a conservative approach and
that people not do dissections when pregnant
however, we will accommodate your wishes if
obstetrician agrees.
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III. DISSECTION INSTRUMENTS AND TECHNIQUES
contain - Probe, Forceps, Scalpel handle, Large
Scissors, Small Scissors and Hemostat
DISSECTION KITS
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CUTTING TOOLS
SCALPEL- get blades from Mark Ratliff
SMALL SCISSORS
LARGE SCISSORS
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GRABBING TOOLS
little projections on tip
RAT-TOOTH FORCEPS
SERRATED FORCEPS
HEMOSTAT
FORCEPS
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SEPARATING TOOLS
HAND WITH FINGERS
LARGE SCISSORS
PROBE
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DISSECTION TECHNIQUE
THE ART OF DISSECTION IS SEPARATING OUT
STRUCTURES NOT CUTTING THEM SOME CUTS NEED TO BE
MADE TO PENETRATE SKIN AFTER INITIAL CUTS MOST
THINGS CAN BE SEPARATED USE SCISSORS TECHNIQUE
BEFORE YOU USE A SCALPEL
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SCISSORS TECHNIQUE
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REMOVAL OF SKIN
SEPARATE DERMIS FROM HYPODERMIS (SUPERFICIAL
FASCIA)
EPIDERMIS DERMIS HYPODERMIS
SUPERFICIAL FASCIA SUPERFICIAL NERVES
AND VESSELS TRAVEL IN HYPODERMIS - FATTY LAYER
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REMOVING SKIN LOOK AT CUT EDGES OF SPECIMENS
CUT IN HYPODERMAL LAYER SUPERFICIAL FASCIA
HYPODERMIS SUPERFICIAL FASCIA
EPIDERMIS DERMIS
SECTION THROUGH SHOULDER
MUSCLE WITH OVERLYING DEEP FASCIA
DELTOID
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HYPODERMIS (SUPERFICIAL FASCIA) CONTAINS NERVES,
ARTERIES
MEDIAL CUTANEOUS NERVE ARM
EPIDERMIS DERMIS
BASILIC VEIN
HYPODERMIS SUPERFICIAL FASCIA
MUSCLE WITH OVERLYING DEEP FASCIA
SOLUTION USE SCISSORS TECHNIQUE IN
SUPERFICIAL FASCIA
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MAKE INCISION FIND INTERSECTION AND SPREAD
OR PULL CORNER
STAY IN SUPERFICIAL FASCIA
IF SEE RED OF MUSCLE YOU ARE TOO DEEP
HOLD WITH HEMOSTAT OR MAKE HOLE AND PULL WITH
FINGER
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DISSECTION INSTRUCTIONS 1- Instructions for
complete dissection of each region handed out 2-
Page numbers are from Grant's Dissector 13th
edition 3- Problem most of you did not buy
dissector in regular course 4- Solution copies
in lab 5- I will make copies for you
and distribute 6- Read pages in dissector before
you do the dissection!
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STRUCTURES TO IDENTIFY ON SPECIMEN
1- Another list has pages and major structures to
identify 2- You will not find all structures
(anatomical variability, preservation, etc.) 3-
This is meant as a guide for study 4- See how
many you can identify
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INITIAL INCISIONS - ARM
1- MIDLINE ON ANTERIOR SIDE OF ARM AND FOREARM
SKIN COMPLETELY 2- MIDLINE ON PALM AND THUMB
SKIN COMPLETELY 3- MIDLINE ON ANTERIOR SIDE OF
EACH FINGER SKIN EACH FINGER INDIVIDUALLY
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INITIAL INCISIONS - THORAX
1- MIDLINE FROM STERNAL NOTCH TO XIPHOID
PROCESS 2- CUT ALONG ANTERIOR SURFACE OF EACH
CLAVICLE TO EDGE OF SPECIMEN 3- CUT FROM XIPHOID
PROCESS LATERALLY AS FAR AS POSSIBLE FROM
ANTERIOR SIDE 4- REMOVE SKIN (AND BREAST IF
FEMALE)
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INITIAL INCISIONS - ABDOMEN/PELVIS
1- MIDLINE CUT FROM XIPHOID PROCESS TO PUBIC BONE
(AROUND UMBILICUS) 2- LATERAL CUT FROM XIPHOID
PROCESS AS FAR AS POSSIBLE FROM ANTERIOR SIDE 3-
LATERAL CUT FROM UMBILICUS LATERALLY AS FAR AS
POSSIBLE FROM ANTERIOR SIDE (NOTE SEE DR. ZILL
IF YOU WANT TO TRY APPENDECTOMY INCISION) 4-
LATERAL CUT FROM PUBIS TO ANTERIOR SUPERIOR ILIAC
SPINE 5- REFLECT FLAPS OF SKIN (ONLY) LATERALLY
AND REMOVE
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INITIAL INCISIONS - HEAD AND NECK
1- MIDLINE OF FACE FROM VERTEX OF SKULL TO UPPER
LIP 2- CUTS AROUND EYES LATERALLY TO POINT
ANTERIOR TO EXTERNAL AUDITORY MEATUS 3- CUT
AROUND MOUTH TO CHIN 4- CUT ALONG MANDIBLE TO
EXTERNAL AUDITORY MEATUS 5- REMOVE SKIN VERY
CAREFULLY
1- CUT LATERALLY ALONG STERNOCLEIDOMASTOID
MUSCLE 2- CUT MIDLINE OF NECK FROM CHIN TO
STERNAL NOTCH 3- REMOVE SKIN ANTERIORLY TO MIDLINE
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CT IMAGES OF CADAVERS
specimen on first table in lab - look at later
this week
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IF YOU PLAN TO START TODAY
1 - Get key to Gross lab if you returned it at
end of course 2- Go to lab, find your
specimen 3- Find lab coat that fits on pegs on
wall of lab 4- Begin incisions and removal of
skin 5- Cover and wet down at end of day
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NOTE YOU CAN WORK ANY TIME YOU WANT 1- You are
not required to come every day set your
own schedule if you need help, come in a find
instructor 2- Please come to clinical
lectures 3- Please stored specimen if you take
a long break (more than 2 days) 4- When you are
done, have me or other instructor review your
work and you will get credit for course 5- If
you need a letter of recommendation, see
me. GOOD LUCK DISSECTING!
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I HAVE AN IDEA DO PROSECTIONS OF SURGICAL
APPROACHES AND PROCEDURES STUDENTS WILL SEE IN
YEARS 3 AND 4
1 - You will all see some surgical procedures in
Years 3 and 4 2- Asked upper class people which
ones Carotid endarterectomies, open heart,
appendectomies, Whipple procedure 3- If you
finish your dissection and want to help let me
know.