No abstract

The supplementation of lecture‐based anatomy teaching with laboratory sessions, involving dissection or anatomical specimens, is commonly used. Hands‐on dissection allows students to handle instruments correctly while actively exploring three‐dimensional anatomy. However, dissection carries a potential risk of sharps and splash injuries. The aim of this study was to quantify the frequency rate of such cases per 1,000 student‐hours of dissection and identify potential factors than might influence safety in anatomy laboratories. Data were retrospectively collected from September 2013 to June 2018 at the University of St Andrews, Scotland, UK. Overall, 35 sharps injuries were recorded in undergraduate medical students, with a frequency rate of 0.384 and no splash cases. A statistically significant, moderate negative association between year of study and frequency rate (rho(25) = −0.663; P < 0.001) was noted. A statistically significant difference in the frequency rate between different semester modules (χ2(4) = 13.577, P = 0.009) was observed with the difference being between Year 1 Semester 2 and Year 3 Semester 1 (P = 0.004). The decreasing trend with advancing year of study might be linked to increasing dissecting experience or the surface area of the region dissected. The following factors might have contributed to increased safety influencing frequency rates: single‐handed blade removal systems; mandatory personal protective equipment; and having only one student dissecting at a given time. The authors propose that safety familiarization alongside standardized training and safety measures, as part of an evidence‐based culture shift, will instill safety conscious behaviors and reduce injuries in anatomy laboratories.

Emergency front of neck airway (eFONA) access by anaesthetists carries a high failure rate, partially due to inability to identify the cricothyroid membrane 1 in the emergency situation. Therefore, it is recommended to identify the cricothyroid membrane before induction of anaesthesia in patients with a predicted difficult airway, 2 if necessary by using ultrasonography. 3,4 Emergency front of neck airway (eFONA) access should be performed with the patient placed in the extended head and neck position as recommended by the Difficult Airway Society. 5

Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years AE 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin-fixed human cadavers (mean age 82.88 years AE 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (AE0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM-HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (AE0.062) along the LM-HF line, with no statistically significant difference between the two groups (U = 764.000; exact two-tailed P = 0.534). It was always on or anterior to the LM-HF line, anterior by 0.74 cm (AE0.624) on ultrasound and by 1.51 cm (AE0.509) during dissection. This point was significantly further anterior to the LM-HF line in cadavers (U = 257.700, exact two-tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasoundguided nerve localization more technically challenging. Clin. Anat. 32:390-395, 2019.

With an ever-expanding use of cross-sectional imaging for diagnostic and therapeutic purposes, there has also been an increase in the need for exposure to such radiological and anatomical views at the undergraduate and postgraduate level to allow for early familiarisation with the relevant anatomy. Cadaveric cross-sections offer an excellent link between the two-dimensional radiological images and the three-dimensional anatomical structures. For such cross-sections to be useful and informative within educational settings, they need to be: (i) safe for students and trainees to handle and (ii) robust enough to withstand repeated handling; as well as (iii) displaying anatomy clearly and accurately. There are various ways in which cross-sections can be prepared and presented; plastinated, potted, vacuum-sealed or unmounted. Each of these approaches has advantages and disadvantages in terms of technical complexity, cost and quality. As an alternative to the above methods and their limitations, we propose the presentation of cadaveric cross-sections in a transparent polyester resin. This technique has been used extensively in craft and artistic industries, yet it is not publicised in anatomy teaching settings. The sections were layered in polyester resin contained within a mould. The set resin required finishing by sanding and polishing. The final cross-sections were safe to handle, durable and maintained excellent anatomical relationships of the contained structures. The transparency of the set resin was water-clear and did not obstruct the visibility of the anatomy. The cost of the process was found to be significantly lower, requiring less infrastructure when compared with alternative methods. The following trivial technical difficulties were noted during the resin-embedding process: trapped air causing organs to float; retained water in the anatomical specimens creating bubbles and discoloration; and microbubbles emerging from the solution affecting the finished surface. However, solutions to these minor limitations have been discussed within the paper with the aim of future proofing this technique. The sections have been used in undergraduate medical teaching for 4 years and they have shown no signs of degradation or discoloration. We believe that this method is a viable and cost-effective alternative to other approaches of displaying cross-sectional cadaveric material and will help students and trainees bridge the gap between the traditional three-dimensional anatomy and two-dimensional images.