Atlas of Forensic Pathology

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ATLAS OF FORENSIC PATHOLOGY

HOW PERFORMED Incisions are made into the back often from the shoulder to the midline, and extended to the lower extremities, and the skin is subsequently reflected from the musculature of the back (Figure 31.7). The incisions can, depending upon the nature of the case, be extended to the wrists and ankles. Examination of the arms in cases of child abuse may reveal injuries (ie, where the child was grabbed). DISSECTION OF THE LOWER EXTREMITIES WHEN PERFORMED The lower extremities are most often dissected after a pulmonary thromboembolus is iden tified in the lungs to confirm the presence of deep venous thrombi in the lower extremities as the source of the embolus in the lung. Identifying and sampling the thrombus in the lower extremities may allow for potential dating of the time frame since the development of the thrombus, which may provide useful information in the investigation. Dissection of the lower extremities is also performed in the evaluation of hit-and-run scenarios to help identify the impact site from the vehicle. HOW PERFORMED The skin of the lower extremity is incised, often from a posterior approach, but potentially also from a medial approach or anterior approach. The underlying musculature is sectioned to examine for a thrombus. DISSECTION OF THE SINOATRIAL AND ATRIOVENTRICULAR NODES WHEN PERFORMED In evaluation of a sudden death, when no cause of death is identified at autopsy, examina tion of the cardiac conduction system can be performed. HOW PERFORMED The sinoatrial node is immediately adjacent to the crista terminalis on the side of the superior vena cava and at the junction with the right atrium. By removing the crista

Figure 31.7. Dissection of the back. The skin and underlying soft tissue is reflected, revealing the underlying musculature. The reflec tion of the skin can be extended to the wrists and ankles, depend ing upon the circumstances of the autopsy and the need to identify injuries of the back and extremities. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023