Monday, November 28, 2022

Reflections from the Cadaver Lab: Week 1 Day 1

Reflecting on my first day teaching this year's Cadaver Lab.

The first two weeks of every December, I teach two back-to-back five-day dissection labs with the Physician Assistant program at the University of Tampa. When I teach this class each December, I attempt to share some thoughts at the end of each day, but this does not always happen. Dissection takes concentration, and when you are in a teaching role for 24 students, you are tired at the end of the day. This year I will follow through and will keep it simple to make sure I stay on task.

Day one involves some identification of surface anatomy and some time with use of instruments, so it is a shorter day of dissection. We start with reflection of the skin on the anterior portion of the body. At some point, we proceed to a slightly deeper level and reflect the superficial fascia and reach the level of the deep fascia or fascia profunda. Below are some thoughts for the day:

  1. When looking at surface anatomy and noting surgical scars, many students become curious and potentially excited about seeing surgical procedures, especially joint replacements. This is perfectly understandable, especially for healthcare providers. However, I am always struck by how much more complicated and sophisticated the human body is compared to manufactured hip or shoulder. These devices have become much more sophisticated over the years, but they are nothing near the original. Even in a pathological joint, the evidence of the intelligence of the body is on display in the attempt to adapt to injury. I think that the real thing is so complex it can be a bit overwhelming, and when we are new to dissection, we can potentially miss so much that we can't fully appreciate it. You need to see many, many dissections to start to understand the tissue. Having said this, I find it very interesting to see replacements and the effects of other surgical procedures. But, I am more interested in seeing how the body has adapted to this new device or procedure.

  2. At any level of dissection, you are studying movement. I don't need to state the obvious that the donors do not have an intact nervous system, so what can one learn about movement from this process? The answer lies in the fascial sliding surface in the body. Muscles, nerves, blood vessels, lymph vessels, organs, and really all of the body surfaces are connected to one another through fascial crosslinks. When you are introducing your scalpel into these fascial spaces between structures, you are assessing the movement potential between these sliding surfaces and how easily they move in relationship to one another. On day one, when you are removing the skin, you see a difference immediately between different donor bodies. However, there are regions where the skin is much more adhered across the board. The knee, for instance, is like this, especially the medial knee. The adipose is much thinner, and the skin is much more tightly bound to the underlying tissues. While we have ligaments to support the knee and the muscles also play a role, the skin seems to have a supportive role, much like a knee brace.

  3. The adipose varies quite a lot in color, ranging from almost a whitish-pale color to yellow to bright orange. Generally, the paler color is on donors who have much more fluid in the tissue space, whereas the dark orange tends to be on leaner bodies with dryer tissue. For the next two weeks, I am teaching Physician Assistant students, and I have a far easier time discussing these color variations with practitioners of Chinese medicine since we have a system to understand things such as Yin deficiency with deficient heat and Yang deficiency with water overflowing.

  4. The platysma is such a cool muscle!

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