Qualitative and quantitative comparison of Thiel and phenol-based soft-embalmed cadavers for surgery training

Surgical skills training has traditionally been limited to formalin embalming that does not provide a realistic model. The aim of this study was to qualitatively and quantitatively compare Thiel and phenol-based soft-embalming techniques: qualitatively in a surgical training setup, and quantitatively by comparing the mechanical and histomorphometric properties of skin specimens embalmed using each method.

Thirty-four participants were involved in surgical workshops comparing Thiel and phenol-based embalmed bodies. Participants were asked to evaluate the utility of the different models for surgical skills training. In parallel, tensile elasticity evaluation was performed on skin flaps from six fresh-frozen cadavers. Flaps were divided into three groups for each specimen: fresh-frozen, Thiel, and phenol-based embalmed and compared together at 1 month or 1 year after embalming. A histological investigation of the skin structural properties was performed for each embalming type using haematoxylin and eosin and Masson's trichrome.

All participants rated the phenol-based specimens consistently better or equivalent to Thiel for the evaluated parameters. Quantitatively, there were statistically significant differences for the tensile elasticity between the embalming techniques (p < .05). There were no significant differences for the tensile elasticity between phenol-based embalmed skin and fresh state (p = .30), and no significant difference between embalming time was reported (p = .47). Histologically, the integrity of the skin was better preserved with the phenol-based technique.

Phenol-based embalming provides as realistic or better of a model as Thiel embalming for surgical training skills and was generally preferred over Thiel model. The phenol-based embalming better preserved the integrity of the skin.