According to international guidelines, we should start internal examination of the body with the opening of the skull and with the investigation of the intracranial content. At our department, we respect this rule. But what are meaningful reasons for such a strategy?
Firstly, textbooks usually recommend dissection of the head prior to the rest of the body. And the advantage? A bloodless field within cervical organs, which is important in asphyxia-related deaths especially in stranglings.
Secondly, it is quite logical to follow a process of dissection "a capite usque ad calcem". External inspection is, also, done from head till feet, sometimes in a counter-clockwise pattern (head - right upper limb - right part of the trunk - right lower limb - left lower limb - left part of the trunk - left upper limb).
Thirdly, after the opening of the skull we may immediately smell the presence of volatile, poisonous substances (e.g., ethanol, cyanide, solvents, etc.) without competing odors from thoracic and abdominal cavity.
How do you see it colleagues? Please advise... Let's share our knowledge.
Dear Henja,
In Turkey, we routinely start with the opening of the skull and with the investigation of the intracranial content in the medico-legal autopsies. Following to surface incision of neck skin, we open thoracic and abdominal cavities. After we examined extremities and finally we deeply examine to neck.
You know that it is important drainage of neck in asphyxia cases for identify to asphyxia lesions from artificial lesions and we can not see ligature marks in external examination if soft tie was used. In many cases, we may not have information about the nature of the event before the start of the autopsy. Therefor, we could be dragged into a mistake if we follow a different path.
For all that, in patients with chest and abdominal injuries, we choose these regions primarily in the autopsy area.
Additionally, I endorse your third reason, too.
Sincerely yours.
As Dr.Henja and Dr. Asirdizer in most of the cases we routinely start opening the skull and then from head to heel, but in those cases where are involved injuries to the neck we always left it to the end. In this way the anatomic structure can drain not only to the head but also to the chest cavity, in our experience we have a better and "clean" neck dissection. So if head should be the first, why don´t let the neck to the end in asphyxia-related deaths?
Best Regards
Generally in post mortem exams, head is opened first. Like it has already been said , in cases where a very good dissection of the neck is needed , I perform it at the end, after opening first the head, and second the thorax and abdomen. However in cases where taking samples of blood for toxicological analysis is needed, and there are lot of injuries overall the body, and it seems that there is a small amount of peripheral blood, I begin opening thorax and abdomen first in order to collect enough blood.
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