Purpose Statement: To outline a specific manner in which to recover research tissue from a cadaveric donor. ARM01 Packaging Set-Up

Transcription

1 ARM01 - Arm Whole TISR.JA.020 LAB 1.1. Make a circumferential incision beginning at the top of the shoulder progressing in an anterior direction, beneath the axilla LAB 1.2. Continue incision in a posterior direction to the shoulder until the original incision line has been met LAB 1.3. Deepen the incision until the blade has exposed the shoulder and arm joint LAB 1.4. Expand the incision if needed until the shoulder capsule can be visualized LAB 1.5. Use a scalpel and make a circumferential incision around the shoulder capsule so the arm loosens away from the torso LAB 1.6. Transect the biceps tendon and any other tissue that is connecting the arm to the torso ARM01 DOCUMENT ID: TISR.JA.020 PAGE 1 OF 1 VERSION DATE: 10/21/13

2 ARM02 - Forearm w/hand w/elbow TISR.JA.021 LAB 1.1. Make a circumferential incision using a scalpel over the mid-shaft of the humerus LAB 1.2. Continue the incision until the blade reaches the bone surface LAB 1.3. Reflect the muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, bisect the humerus ARM02 DOCUMENT ID: TISR.JA.021 PAGE 1 OF 1 VERSION DATE: 10/21/13

3 ARM03 - Hand TISR.JA.022 LAB 1.1. Using a blade, make a circumferential incision approximately over the mid-shaft of the radius and ulna LAB 1.2. Continue the incision until the blade reaches the bone surface LAB 1.3. Reflect the muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, transect the radius and ulna ARM03 DOCUMENT ID: TISR.JA.022 PAGE 1 OF 1 VERSION DATE: 10/21/13

4 ARM04 - Finger TISR.JA.023 LAB 1.1. Using a blade, make a circumferential incision at the base of the metacarpal LAB 1.2. Continue the incision until the blade reaches the bone surface LAB 1.3. Reflect muscle away to expose bone surface LAB 1.4. Using an autopsy saw, transect finger away from hand LAB 1.5. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor ARM04 DOCUMENT ID: TISR.JA.023 PAGE 1 OF 1 VERSION DATE: 4/7/14

5 BLO01 - Serum Separator Tube TISR.JA.024 LAB 1.1. Obtain blood sample from the donor s subclavian or femoral vein Note: If a cardiac draw of cut-down must be performed, obtain manager or designee approval LAB 1.2. Draw approximately 20cc of blood into a syringe. Transfer the drawn blood from the syringe into two Serum Separator Tubes (SST) Note: Distribute the blood equally between the two tubes. One will be sent to the laboratory and the other will be kept in frozen storage LAB 1.3. Write the technician s initials, draw date, and draw time on two donor code labels LAB 1.4. Affix the labels to the tubes containing the blood sample LAB 1.5. Place the samples in the centrifuge and spin them for 15 minutes LAB 1.6. Complete the draw, centrifuge, and submission information on the blood testing panel requisition form LAB 1.7. Place the blood testing panel requisition form into a plastic bag and place it next to the centrifuge so that the spun tube can be placed into the bag for transportation to the testing laboratory LAB 1.8. Take the spun blood out of the centrifuge and place one tube into the plastic bag for transport to the blood testing laboratory and the second tube into Freezer 1 aliquot storage container. BLO01 DOCUMENT ID: TISR.JA.024 PAGE 1 OF 1 VERSION DATE: 10/21/13

6 BLO02 - EDTA Tube TISR.JA.025 LAB 1.1. Obtain blood sample from the donor s subclavian or femoral vein Note: If a cardiac draw of cut-down must be performed, obtain manager or designee approval LAB 1.2. Draw approximately 20cc of blood into a syringe. Transfer the drawn blood from the syringe into two EDTA tubes Note: Distribute the blood equally between the two tubes. One will be sent to the laboratory and the other will be kept in frozen storage. LAB 1.3. Write the technician s initials, draw date, and draw time on two donor code labels LAB 1.4. Affix the labels to the tubes containing the blood sample LAB 1.5. Package in designated boxes BLO02 DOCUMENT ID: TISR.JA.025 PAGE 1 OF 1 VERSION DATE: 10/21/13

7 BON01 - Tibia TISR.JA.026 LAB 1.1. Make a longitudinal skin incision with a scalpel from the medial side of the knee extending medially to the dorsum of the foot LAB 1.2. Using a blade, transect the remaining tissue attachments on the inferior aspect of the patella LAB 1.3. Dissect the muscles away from the medial and lateral sides of the tibia LAB 1.4. Continue the deep muscle dissection from the tibia Note: Keeping the blade close to the bone at a slight angle will assist in the reduction of loose tissue on the bone LAB 1.5. Create a handle at the proximal end of the tibia by continuing the deep muscle incision on the posterior side of the bone LAB 1.6. While lifting the handle, the fibula can be disarticulated from the tibia at the tibial-fibular joint LAB 1.7. While lifting the proximal end of the tibia towards the foot, continue cutting the soft tissue attachments away from the bone LAB 1.8. Disarticulate the tibia from the ankle joint BON01 DOCUMENT ID: TISR.JA.026 PAGE 1 OF 1 VERSION DATE: 10/21/13

8 BON02 - Fibula TISR.JA.027 LAB 1.1. Make a longitudinal skin incision with a scalpel from the medial side of the knee extending medially to the dorsum of the foot LAB 1.2. Using a blade, transect the remaining tissue attachments on the inferior aspect of the patella LAB 1.3. Dissect the muscles away from the medial and lateral sides of the fibula LAB 1.4. Continue the deep muscle dissection from the tibia Note: Keeping the blade close to the bone at a slight angle will assist in the reduction of loose tissue on the bone LAB 1.5. Create a handle at the proximal end of the fibula by continuing the deep muscle incision on the posterior side of the bone LAB 1.6. While lifting the handle, the fibula can be disarticulated from the tibia at the tibial-fibular joint LAB 1.7. While lifting the proximal end of the femur towards the foot, continue cutting the soft tissue attachments away from the bone LAB 1.8. Disarticulate the tibia from the ankle joint LAB 1.9. Dissect the fibula from the tibia by removal of the musculoskeletal attachments including the talus and calcaneus BON02 DOCUMENT ID: TISR.JA.027 PAGE 1 OF 1 VERSION DATE: 10/21/13

9 BON03 - Femur TISR.JA.028 LAB 1.1. Make a diagonal incision through the quads from the anterior iliac spine to the medial condyle of the femur LAB 1.2. Reflect the muscle attachments from the shaft by keeping the blade as close to the bone as possible Note: Keeping the blade close to the bone at a slight angle will assist in the reduction of loose tissue on the bone LAB 1.3. Continue the dissection around the distal side of the shaft LAB 1.4. Transect the distal quads 1 ½ inch superior to the patella LAB 1.5. Open the knee joint capsule and lift the patella LAB 1.6. Cut the lateral and medial capsule walls of the knee down to the tibial plateau LAB 1.7. Reflect the patella down onto the anterior tibia LAB 1.8. Lift the femur at the exposed distal end, remove the muscle around this end LAB 1.9. Disarticulate the knee joint to separate the femur from surrounding tissue LAB Lift the distal femur upward toward the femoral head while cutting the tissue from the femur LAB Move the distal end of the femur medially to expose the hip capsule LAB Make a circumferential incision of the capsule using a scalpel while moving the distal femur medially LAB Transect the femoral ligament from the femoral head BON03 DOCUMENT ID: TISR.JA.028 PAGE 1 OF 1 VERSION DATE: 10/21/13

10 BON04 - Proximal Femur TISR.JA.029 LAB 1.1. Make a diagonal incision through the quads from the anterior iliac spine to the medial condyle of the femur LAB 1.2. Reflect the muscle attachments from the shaft by keeping the blade as close to the bone as possible Note: Keeping the blade close to the bone at a slight angle will assist in the reduction of loose tissue on the bone LAB 1.3. Lift the femur at the exposed distal end and remove the muscle around this end LAB 1.4. Bisect the mid femur using an autopsy saw 2 inches superior to the knee LAB 1.5. Lift the distal femur upward toward the femoral head while cutting the tissue from the femur LAB 1.6. Move the distal end of the femur medially to expose the hip capsule LAB 1.7. Make a circumferential incision of the capsule using a scalpel while moving the distal femur medially LAB 1.8. Transect the femoral ligament from the femoral head BON04 DOCUMENT ID: TISR.JA.029 PAGE 1 OF 1 VERSION DATE: 10/21/13

11 BON05 - Patella TISR.JA.030 LAB 1.1. Make a diagonal incision through the quads from the anterior iliac spine to the medial side of the knee LAB 1.2. Extend the incision medially to the dorsum of the foot LAB 1.3. Dissect skin and muscle tissue away from the patella LAB 1.4. Dissect patella away from quadriceps tendon and patellar ligament BON05 DOCUMENT ID: TISR.JA.030 PAGE 1 OF 1 VERSION DATE: 10/21/13

12 BON06 - Humerus TISR.JA.031 LAB 1.1. Make a longitudinal incision using a scalpel over the coracoid process, extending laterally over the deltoid and lateral aspect of the arm LAB 1.2. Continue to the junction of the carpal and metacarpal bones for adequate exposure to all the arm bones LAB 1.3. Dissect the muscle and soft tissue away from the bone at the distal end of humerus, in a proximal direction Note: Keeping the blade close to the bone at a slight angle will assist in the reduction of loose tissue on the bone LAB 1.4. Pull the humerus distally once the dissection has reached the shoulder joint LAB 1.5. Pull the humerus head away from the glenoid cavity LAB 1.6. Use a scalpel and transect the rotator cuff along with any remaining tendon attachments LAB 1.7. Use a scalpel and transect the remaining attachments to the radius and ulna at the distal end of humerus BON06 DOCUMENT ID: TISR.JA.031 PAGE 1 OF 1 VERSION DATE: 10/21/13

13 BON07 - Ribs TISR.JA.032 LAB 1.1. Use a scalpel and make an incision from above the sternum inferiorly to the umbilicus LAB 1.2. Reflect the tissue away from the anterior aspect of the ribs to the lateral midline LAB 1.3. Make transverse incision through diaphragm LAB 1.4. Make incision through lower colon and remove internals LAB 1.5. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.6. Use an autopsy saw and transect ribs 1-7 at each sternal attachment LAB 1.7. Use an autopsy saw and transect ribs 8-10 at the connecting cartilage of the previous rib LAB 1.8. Use a scalpel blade and dissect ribs 1-12 away from each of its muscular and soft tissue attachments Note: Keeping the blade close to the bone at a slight angle will assist in the reduction of loose tissue on the bone LAB 1.9. Use an autopsy saw and transect ribs 1-12 at each junction with the spinal transverse process BON07 DOCUMENT ID: TISR.JA.032 PAGE 1 OF 1 VERSION DATE: 10/21/13

14 BON08 - Radius TISR.JA.033 LAB 1.1. Make a longitudinal incision using a scalpel starting at the distal end of the humerus and ending at the junction of the carpal and metacarpal bones LAB 1.2. Use a scalpel and transect the attachments to the radius and ulna at the distal end of humerus LAB 1.3. Dissect the radius away from its attachments to the ulna LAB 1.4. Lift the proximal end of the radius and dissect away the muscle and soft tissue attachments LAB 1.5. Dissect the distal end of the radius from its attachments to the carpal bones and ulna BON08 DOCUMENT ID: TISR.JA.033 PAGE 1 OF 1 VERSION DATE: 10/21/13

15 BON09 - Bone Other TISR.JA.034 LAB 1.1. Consult with an immediate supervisor to determine the procedure for the recovery of bone that is not listed in the United Tissue Network Standard Operating Procedures Manual DOCUMENT ID: TISR.JA.034 PAGE 1 OF 1 VERSION DATE: 10/21/13

16 CAD01 - Cadaver Embalmed TISR.JA.035 LAB 1.1. Obtain donor from being embalmed LAB 1.2. Remove any fluid found to be in the body/transport bag LAB 1.3. Spray the donor with Dis-Spray solution and let sit for 5-10 minutes LAB 1.4. Use one terry cloth and wipe down entire donor LAB 1.5. Spray the donor with Anti-dehydration Humectant and let sit for 5-10 minutes LAB 1.6. Use one terry cloth and wipe down entire donor LAB 1.7. Attach metal identification tag to cadaver s right side on inferior ear cartilage LAB 1.8. Write metal identification tag number on TISR.FM.004 Tissue Recovery List LAB 1.9. Place donor into Cooler 2 until ready for shipment LAB Follow TISR.JA.011 Packaging Embalmed Specimens for wrapping instructions LAB Using the clippers, buzz scalp and facial hair DOCUMENT ID: TISR.JA.035 PAGE 1 OF 1 VERSION DATE: 3/1/16

17 CAD02 - Cadaver TISR.JA.036 LAB 1.1. Attach metal identification tag to the cadaver s right side on inferior ear cartilage LAB 1.2. Write metal identification tag number on TISR.FM.004 Tissue Recovery List LAB 1.3. Prep bowel LAB 1.4. Place donor into Cooler 2 until ready for shipment LAB 1.5. Follow TISR.JA.011 Packaging Embalmed Specimens LAB LAB 1.6. Using the clippers, buzz scalp and facial hair DOCUMENT ID: TISR.JA.036 PAGE 1 OF 1 VERSION DATE: 3/1/16

18 CAR01 - Heart TISR.JA.037 LAB 1.1. Follow TISR.JA.042 CEP01. LAB 1.2. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel. LAB 1.3. Using a scalpel transect all tissue connecting internals to rib cavity. LAB 1.4. Transect trachea and pull heart and lung block out of internal cavity. LAB 1.5. Transect all valves and vessels attaching the heart. LAB 1.6. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor. CAR01 DOCUMENT ID: TISR.JA.037 PAGE 1 OF 1 VERSION DATE: 10/21/13

19 CAR02 - Heart w/aorta TISR.JA.038 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.3. Using a scalpel transect all tissue connecting internals to rib cavity LAB 1.4. Transect trachea and pull heart and lung block out of internal cavity LAB 1.5. Transect superior and inferior vena cave LAB 1.6. Transect brachiocephalic trunk, left common carotid artery and left subclavian artery without harming the aortic arch LAB 1.7. Transact abdominal aorta LAB 1.8. Transect all over valves and vessels attaching the heart LAB 1.9. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor CAR02 DOCUMENT ID: TISR.JA.038 PAGE 1 OF 1 VERSION DATE: 10/21/13

20 CAR03 - Aorta TISR.JA.039 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.3. Using a scalpel transect all tissue connecting internals to rib cavity LAB 1.4. Carefully remove all abdominal organs while leaving the thoracic aorta and abdominal aorta intact LAB 1.5. Transect Common iliac arteries one inch posterior of where the aorta ends LAB 1.6. Transect trachea and pull heart and lung block out of internal cavity LAB 1.7. Transect Aorta Arch from the heart at the aortic root LAB 1.8. Transect all other valves and vessels attaching the entire aorta LAB 1.9. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by manger or designee CAR03 DOCUMENT ID: TISR.JA.039 PAGE 1 OF 1 VERSION DATE: 7/14/14

21 CAR04 - Lung TISR.JA.040 LAB 1.1. Follow TISR.JA.042 CEP01. LAB 1.2. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.3. Using a scalpel transect all tissue connecting internals to rib cavity LAB 1.4. Transect trachea and pull heart and lung block out of internal cavity LAB 1.5. Remove heart LAB 1.6. Transect primary bronchi at medial side of lung LAB 1.7. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor CAR04 DOCUMENT ID: TISR.JA.040 PAGE 1 OF 1 VERSION DATE: 10/21/13

22 CAR05 - Heart/Lung Block TISR.JA.041 LAB 1.1. Follow TISR.JA.042 CEP01. LAB 1.2. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel. LAB 1.3. Using a scalpel transect all tissue connecting internals to rib cavity. LAB 1.4. Transect trachea and pull heart and lung block out of internal cavity. LAB 1.5. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor. CAR05 DOCUMENT ID: TISR.JA.041 PAGE 1 OF 1 VERSION DATE: 10/21/13

23 CEP01 - Cephalus TISR.JA.042 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Continue the incision until the cervical spine is exposed LAB 1.3. Use a scalpel and make an incision thru the spinal disc that lies between C7 and T1 LAB 1.4. Insert an osteotome into the incision line LAB 1.5. Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB 1.6. Re-position the osteotome as needed LAB 1.7. Transect any remaining tissue attachments with a scalpel LAB 1.8. Using the clippers, buzz scalp and facial hair CEP01 DOCUMENT ID: TISR.JA.042 PAGE 1 OF 1 VERSION DATE: 3/1/16

24 CEP02 - Cephalus w/ Cervical Spine TISR.JA.043 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Continue the incision until the cervical spine is exposed LAB 1.3. Use an autopsy saw to cut through ribs 1 and 2 LAB 1.4. Use a scalpel and make an incision into the spinal disc that lies between T2 and T3 LAB 1.5. Insert an osteotome into the incision line LAB 1.6. Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB 1.7. Re-position the osteotome as needed LAB 1.8. Use an autopsy saw to remove the ribs at their attachments to the spine LAB 1.9. Transect any remaining tissue attachments with a scalpel LAB Using the clippers, buzz scalp and facial hair CEP02 DOCUMENT ID: TISR.JA.043 PAGE 1 OF 1 VERSION DATE: 3/1/16

25 CEP03 - Cephalus w/thoracic Spine TISR.JA.044 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.3. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.4. Make transverse incision through diaphragm LAB 1.5. Make incision through lower colon and remove internals LAB 1.6. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.7. Wash cavity with water LAB 1.8. Use a scalpel and make an incision thru the spinal disc that lies between T12 and L1 LAB 1.9. Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Re-position the osteotome as needed LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Transect any remaining tissues with a scalpel LAB Using the clippers, buzz scalp and facial hair CEP03 DOCUMENT ID: TISR.JA.044 PAGE 1 OF 1 VERSION DATE: 3/1/16

26 CEP04 - Cephalus w/lumbar w/sacrum TISR.JA.045 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.3. Make an additional incision bilaterally from the umbilicus to the left and right iliac crests LAB 1.4. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.5. Make transverse incision through diaphragm LAB 1.6. Make incision through lower colon and remove internals LAB 1.7. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.8. Use a scalpel and reflect the muscle and connective tissue from the anterior right and left Ilium LAB 1.9. Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the right and left sacroiliac junctions are completely separated LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Transect any remaining tissues with a scalpel LAB Using the clippers, buzz scalp and facial hair CEP04 DOCUMENT ID: TISR.JA.045 PAGE 1 OF 1 VERSION DATE: 3/1/16

27 CEP05 - Temporal Bone TISR.JA.046 LAB 1.1. Use a scalpel and make incision around the circumference of the cephalus just above the ears LAB 1.2. Remove entire scalp from the calvarium LAB 1.3. Use an autopsy saw and cut through the calvarium using the remaining skin on the lower half of the cephalus as a guide LAB 1.4. Remove calvarium to expose the brain LAB 1.5. Remove the brain by transecting spinal cord and all other attached tissues LAB 1.6. Use a scalpel and make an incision on both sides of the cephalus 1 inch anterior to the ears meeting each incision under the jaw LAB 1.7. Use an autopsy saw and cut coronally thru anterior part of the cephalus 1 inch anterior to ear and anterior to sella turcica, using previous incision as a guide LAB 1.8. Use a scalpel and make incision 3 inches posterior from ear canal LAB 1.9. Use an autopsy saw and cut on the incision line made in LAB1.8 LAB Transect remaining tissue CEP05 DOCUMENT ID: TISR.JA.046 PAGE 1 OF 1 VERSION DATE: 9/30/15

28 EXC01 - Stomach Excretory TISR.JA.047 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate stomach LAB 1.3. Transect esophagus at proximal end of the stomach LAB 1.4. Transect duodum at the distal end of the stomach LAB 1.5. Transect all omentum and other attaching vessels and tissues LAB 1.6. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC01 DOCUMENT ID: TISR.JA.047 PAGE 1 OF 1 VERSION DATE: 10/21/13

29 EXC02 - Kidney TISR.JA.048 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Carefully reflect intestines and stomach to locate the kidney LAB 1.3. Transect ureter at medial side of kidney LAB 1.4. Transect all other blood vessels LAB 1.5. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC02 DOCUMENT ID: TISR.JA.048 PAGE 1 OF 1 VERSION DATE: 10/21/13

30 EXC03 - Liver TISR.JA.049 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any tissue and organs necessary to locate liver LAB 1.3. Transect left hepatic vein and common bile duct LAB 1.4. Transect any other blood vessels and tissues attaching liver to body, be careful not to nick the liver LAB 1.5. Place loose tag into plastic bag, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC03 DOCUMENT ID: TISR.JA.049 PAGE 1 OF 1 VERSION DATE: 10/21/13

31 EXC04 - Bladder TISR.JA.050 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate bladder LAB 1.3. Transect both left and right ureter LAB 1.4. Transect urethra LAB 1.5. Transect all remaining attaching vessels and tissues LAB 1.6. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC04 DOCUMENT ID: TISR.JA.050 PAGE 1 OF 1 VERSION DATE: 10/21/13

32 EXC05 - Prostate TISR.JA.051 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate bladder and prostate LAB 1.3. Carefully transect bladder away from prostate LAB 1.4. Transect the Urethra LAB 1.5. Transect all remaining attaching vessels and tissues LAB 1.6. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC05 Bladder Prostate DOCUMENT ID: TISR.JA.051 PAGE 1 OF 1 VERSION DATE: 7/14/14

33 EXC06 - Pancreas TISR.JA.052 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate stomach, duodenum, and pancreas LAB 1.3. Carefully transect stomach and duodenum away from pancreas making sure not to nick the pancreas LAB 1.4. Transect all remaining attaching vessels and tissues away from the pancreas LAB 1.5. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC06 DOCUMENT ID: TISR.JA.052 PAGE 1 OF 1 VERSION DATE: 10/21/13

34 EXC07 - Gallbladder TISR.JA.053 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate the liver and gallbladder LAB 1.3. Transect left hepatic vein and the common bile duct LAB 1.4. Transect any other blood vessels and tissues attaching liver and gallbladder to the body LAB 1.5. Once liver and gallbladder is removed carefully transect gallbladder away from the liver LAB 1.6. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor EXC07 DOCUMENT ID: TISR.JA.053 PAGE 1 OF 1 VERSION DATE: 10/21/13

35 EXC08 - Intestine TISR.JA.054 LAB 1.1. Consult with immediate supervisor to determine the procedure for recovery of intestines DOCUMENT ID: TISR.JA.054 PAGE 1 OF 1 VERSION DATE: 10/21/13

36 EXC09 - Urine TISR.JA.055 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate the bladder LAB 1.3. Using a syringe with needle, puncture bladder and draw as much urine from bladder as needed LAB 1.4. Transfer the drawn urine into an approved container(s) LAB 1.5. Affix donor label(s) to the container(s) DOCUMENT ID: TISR.JA.055 PAGE 1 OF 1 VERSION DATE: 10/21/13

37 INT01 - Skin TISR.JA.056 LAB 1.1. Consult with an immediate supervisor to determine size, thickness, and area of skin that needs to be recovered DOCUMENT ID: TISR.JA.056 PAGE 1 OF 1 VERSION DATE: 10/21/13

38 INT02 - Adipose Tissue TISR.JA.057 LAB 1.1. Consult with an immediate supervisor to determine amount and area of body adipose tissue needs to be recovered DOCUMENT ID: TISR.JA.057 PAGE 1 OF 1 VERSION DATE: 10/21/13

39 INT03 - Muscle Other TISR.JA.058 LAB 1.1. Consult with an immediate supervisor to determine the procedure for the recovery of any internal that is not listed in the United Tissue Network Standard Operating Procedure Manual DOCUMENT ID: TISR.JA.058 PAGE 1 OF 1 VERSION DATE: 10/21/13

40 INT04 - Achilles Tendon TISR.JA.059 LAB 1.1. Follow TISR.JA.068 LEG04 LAB 1.2. Make an incision from the top of the LEG04 to the bottom on the medial side of LEG04 LAB 1.3. Carefully reflect skin away from the posterior side of the LEG04 LAB 1.4. Locate Achilles tendon LAB 1.5. Remove any remaining gastrocenemius muscle LAB 1.6. Carefully slant reflectory Achilles tendon away from soleus muscle LAB 1.7. Transect Achilles tendon away from calcaneus LAB 1.8. Transect any remaining tissue needed to procure Achilles tendon LAB 1.9. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor INT04 DOCUMENT ID: TISR.JA.059 PAGE 1 OF 1 VERSION DATE: 10/21/13

41 INT05 - Tibialis Anterior TISR.JA.060 LAB 1.1. Follow TISR.JA.069 LEG05 LAB 1.2. Make an incision from the top of the tibial plateau to the bottom of the tibia on the lateral side LAB 1.3. Carefully transect skin away from muscle moving medially LAB 1.4. Locate tibialis anterior LAB 1.5. Transect tibialis anterior away from oliotimal tract LAB 1.6. Transect tibialis anterior away from tibia LAB 1.7. Transect any remaining tissue or vessels LAB 1.8. Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor INT05 DOCUMENT ID: TISR.JA.060 PAGE 1 OF 1 VERSION DATE: 10/21/13

42 INT06 - Gracilis TISR.JA.061 LAB 1.1. Using a scalpel make a slight incision from the pubic bone to the knee LAB 1.2. Carefully transect the epidermis and adipose layer to expose muscle LAB 1.3. Transect Gracilis from the origin point, inferior ramus of pubis LAB 1.4. Transect Gracilis from the insertion point: the medial surface of the tibia LAB 1.5. Transect all other muscles, and tissues away from the gracilis LAB 1.6 Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor INT06 DOCUMENT ID: TISR.JA.061 PAGE 1 OF 1 VERSION DATE: 7/14/14

43 INT07 - Semi-T TISR.JA.062 LAB 1.1. Using a scalpel make a slight incision from the pubic bone to the knee LAB 1.2. Carefully transect the epidermis and adipose layer to expose muscle LAB 1.3. Transect semitendinosus from the origin point, ischial tuberosity LAB 1.4. Transect semitendinosus from the insertion point: proximal, medial surface of tibia near insertion of gracilis LAB 1.5. Transect all other muscles, and tissues away from the semitendinosus LAB 1.6 Place loose tag into plastic, then place into another plastic bag that is sealed but not vacuum tight, unless otherwise instructed by supervisor INT07 DOCUMENT ID: TISR.JA.062 PAGE 1 OF 1 VERSION DATE: 7/14/14

44 INT08 - Synovial Fluid TISR.JA.063 LAB 1.1. Follow TISR.JA.067 LEG03 LAB 1.2. Using a syringe, puncture the knee joint on the lateral side in the space between the tibial plateau and the base of the femur LAB 1.3. Once the synovial membrane has been punctured draw synovial fluid into syringe (fluid should be hay color in appearance) LAB 1.4 Transfer fluid into an approved container DOCUMENT ID: TISR.JA.063 PAGE 1 OF 1 VERSION DATE: 10/21/13

45 INT09 - Internal Other TISR.JA.064 LAB 1.1. Consult with an immediate supervisor to determine the procedure for the recovery of any internal that is not listed in the United Tissue Network Standard Operating Procedure Manual DOCUMENT ID: TISR.JA.064 PAGE 1 OF 1 VERSION DATE: 10/21/13

46 LEG01 - Leg Whole TISR.JA.065 LAB 1.1. Use a scalpel and make an incision at the iliac crest extending it medially towards the groin at a 45 degree angle LAB 1.2. Continue the incision until the femoral neck is located LAB 1.3. Force the distal end of the leg towards the midline and make an incision with a scalpel around the femoral neck until the entire capsule has been transected circumferentially LAB 1.4. Disarticulate the femoral head from the acetabulum while bisecting the ligament of the head of the femur LAB 1.5. Use a scalpel and continue posterior incision of the leg until it is separated while leaving enough skin to sew up the torso if necessary LEG01 DOCUMENT ID: TISR.JA.065 PAGE 1 OF 1 VERSION DATE: 10/21/13

47 LEG02 - Knee to Toe TISR.JA.066 LAB 1.1. Use a scalpel and make an incision thru all skin and muscle at the mid-shaft of the femur LAB 1.2. Make a circumferential incision with scalpel until ¾ inch exposure of femur LAB 1.3. Use an autopsy saw and bisect the femur LAB 1.4. Use a scalpel and dissect remaining attached muscles to detach the leg LEG02 DOCUMENT ID: TISR.JA.066 PAGE 1 OF 1 VERSION DATE: 10/21/13

48 LEG03 - Knee TISR.JA.067 LAB 1.1. Use a scalpel and make an incision thru all skin and muscle 8 inches proximal of the femur LAB 1.2. Make a circumferential incision with scalpel until ¾ inch exposure of femur LAB 1.3. Make a circumferential incision at the mid-shaft of the tibia/fiblula with scalpel until ¾ inch exposure of tibia/fibula LAB 1.4. Use an autopsy saw and bisect the femur LAB 1.5. Use a scalpel and dissect remaining attached muscles to detach the leg LAB 1.6. Use an autopsy saw and bisect the full thickness of the tibia and fibula LAB 1.7. Use a scalpel and dissect remaining attached muscles to detach the lower leg from the foot LEG03 DOCUMENT ID: TISR.JA.067 PAGE 1 OF 1 VERSION DATE: 9/30/15

49 LEG04 - Foot TISR.JA.068 LAB 1.1. Make a circumferential incision at the mid-shaft of the tibia/fiblula with scalpel until ¾ inch exposure of tibia/fibula LAB 1.2. Use an autopsy saw and bisect the full thickness of the tibia and fibula LAB 1.3. Use a scalpel and dissect remaining attached muscles to detach the foot from the lower leg LEG04 DOCUMENT ID: TISR.JA.068 PAGE 1 OF 1 VERSION DATE: 10/21/13

50 LEG05 - Tibial Plateau to Foot TISR.JA.069 LAB 1.1. Make a circumferential incision using a scalpel starting at the popliteal fossa LAB 1.2. Bisect the patellar ligament LAB 1.3. Make an incision with a scalpel until the lateral and medial collateral ligaments are severed LAB 1.4. Transect the anterior and posterior cruciate ligaments LAB 1.5. Transect any remaining soft tissue attachments and detach the lower leg LEG05 DOCUMENT ID: TISR.JA.069 PAGE 1 OF 1 VERSION DATE: 10/21/13

51 NER01 - Brain TISR.JA.070 LAB 1.1. Use a scalpel and make incision around the circumference of the cephalus just above the ears LAB 1.2. Remove entire scalp from the calvarium LAB 1.3. Use an autopsy saw and cut through the calvarium using the remaining skin on the lower half of the cephalus as a guide LAB 1.4. Remove calvarium to expose the brain LAB 1.5. Remove the brain by transecting spinal cord and all other attached tissues LAB 1.6. Place loose tag and brain into container then place container top until it snaps, unless otherwise instructed by supervisor NER01 DOCUMENT ID: TISR.JA.070 PAGE 1 OF 1 VERSION DATE: 9/30/15

52 NER03 - Nerves TISR.JA.072 LAB 1.1. Consult with an immediate supervisor to determine the procedure for the recovery of any item that is not listed in the United Tissue Network Standard Operating Procedure Manual DOCUMENT ID: TISR.JA.072 PAGE 1 OF 1 VERSION DATE: 10/21/13

53 NER04 - Spinal Cord TISR.JA.073 LAB 1.1. Consult with an immediate supervisor to determine the procedure for the recovery of any item that is not listed in the United Tissue Network Standard Operating Procedure Manual DOCUMENT ID: TISR.JA.073 PAGE 1 OF 1 VERSION DATE: 10/21/13

54 PEL01 - Pelvis TISR.JA.075 LAB 1.1. Follow TISR.JA.065 LEG01 LAB Leave skin to suture pelvis LAB 1.2. Follow TISR.JA.094 SPI01 LAB 1.3. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.4. Transect any remaining tissue attachments with a scalpel LAB 1.5. Suture amputated sides PEL01 DOCUMENT ID: TISR.JA.075 PAGE 1 OF 1 VERSION DATE: 10/21/13

55 PEL02 - Pelvis w/proximal Femur TISR.JA.076 LAB 1.1. Follow TISR.JA.066 LEG02 LAB Leave skin to suture pelvis LAB 1.2. Follow TISR.JA.094 SPI01 LAB 1.3. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.4. Transect any remaining tissue attachments with a scalpel LAB 1.5. Suture amputated sides PEL02 DOCUMENT ID: TISR.JA.076 PAGE 1 OF 1 VERSION DATE: 10/21/13

56 PEL03 - Pelvis to Toe Tip w/sacrum TISR.JA.077 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.3. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.4. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.5. Make transverse incision through diaphragm LAB 1.6. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.7. Make incision through lower colon and remove internals LAB 1.8. Wash cavity with water LAB 1.9. Use a scalpel and cut thru vertebral disc between L2 and L3 LAB Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Remove musculature from anterior ilium using a scalpel or osteotome LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Use a scalpel to transect any remaining tissue attachments LAB Suture amputated sites PEL03 DOCUMENT ID: TISR.JA.077 PAGE 1 OF 1 VERSION DATE: 9/30/15

57 PEL04 - Pelvis to Toe Tip TISR.JA.078 LAB 1.1. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.2. Cut between the sacroiliac joints and remove the sacrum LAB 1.3. Transect any remaining tissue attachments with a scalpel LAB 1.4. Suture amputated sites PEL04 DOCUMENT ID: TISR.JA.078 PAGE 1 OF 1 VERSION DATE: 11/22/13

58 PEL05 - Pelvis w/proximal Femur and Aorta TISR.JA.079 LAB 1.1. Follow TISR.JA.066 LEG02 LAB Leave skin to sew pelvis LAB 1.2. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.3. Cut between the sacroiliac joints and remove the sacrum LAB 1.4. Transect any remaining tissue attachments with a scalpel LAB 1.5. Suture amputated sites PEL05 DOCUMENT ID: TISR.JA.079 PAGE 1 OF 1 VERSION DATE: 11/22/13

59 PEL06 - Hemi Pelvis TISR.JA.080 LAB 1.1. Follow TISR.JA.065 LEG01 LAB Leave skin to sew up pelvis LAB 1.2. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.3. Cut between the sacroiliac joints and remove the sacrum LAB 1.4. Transect any remaining tissue attachments with a scalpel LAB 1.5. Use an autopsy saw to dissect the pubic bone down the midline LAB 1.6. Transect any remaining tissue attachments with a scalpel LAB 1.7. Suture amputated sites PEL06 DOCUMENT ID: TISR.JA.080 PAGE 1 OF 1 VERSION DATE: 11/22/13

60 PEL07 - Hemi Pelvis w/proximal Femur TISR.JA.081 LAB 1.1. Follow TISR.JA.066 LEG02 LAB 1.2. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.3. Cut between the sacroiliac joints and remove the sacrum LAB 1.4. Transect any remaining tissue attachments with a scalpel LAB 1.5. Use an autopsy saw to dissect the pubic bone down the midline LAB 1.6. Transect any remaining tissue attachments with a scalpel LAB 1.7. Suture amputated sites PEL07 DOCUMENT ID: TISR.JA.081 PAGE 1 OF 1 VERSION DATE: 11/22/13

61 PEL08 - Hemi Pelvis to Toe Tip TISR.JA.082 LAB 1.1. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.2. Cut between the sacroiliac joints and remove the sacrum LAB 1.3. Transect any remaining tissue attachments with a scalpel LAB 1.4. Use an autopsy saw to dissect the pubic bone down the midline LAB 1.5. Transect any remaining tissue attachments with a scalpel LAB 1.6. Suture amputated sites PEL08 DOCUMENT ID: TISR.JA.082 PAGE 1 OF 1 VERSION DATE: 11/22/13

62 PEL09 - Pelvis w/proximal Femur w/sacrum TISR.JA.083 LAB 1.1. Follow TISR.JA.066 LEG02 LAB 1.2. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.3. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.4. Use a scalpel and make an incision 1 inch superior to the iliac crest extending it circumferentially around the abdomen LAB 1.5. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.6. Make transverse incision through diaphragm LAB 1.7. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.8. Make incision through lower colon and remove internals LAB 1.9. Wash cavity with water LAB Use a scalpel and cut thru vertebral disc between L2 and L3 LAB Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Remove musculature from anterior ilium using a scalpel or osteotome LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Use a scalpel to transect any remaining tissue attachments LAB Suture amputated sites PEL09 DOCUMENT ID: TISR.JA.083 PAGE 1 OF 1 VERSION DATE: 9/30/15

63 REP01 - Uterus TISR.JA.084 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate uterus LAB 1.3. Transect uterine tube (Fallopian tube) on both sides LAB 1.4. Transect ovarian ligament on both sides LAB 1.5. Transect vaginal wall just below the cervix LAB 1.6. Carefully transect broad ligament all the way around the uterus LAB 1.7. Transect all other attached vessels and tissue REP01 DOCUMENT ID: TISR.JA.084 PAGE 1 OF 1 VERSION DATE: 10/21/13

64 REP02 - Uterus with Ovaries TISR.JA.085 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate uterus and ovaries LAB 1.3. Transect vaginal wall just below the cervix LAB 1.4. Carefully transect broad ligament all the way around the uterus and ovaries detached them from body LAB 1.5. Transect all other attached vessels and tissue REP02 DOCUMENT ID: TISR.JA.085 PAGE 1 OF 1 VERSION DATE: 10/21/13

65 REP03 - Ovary TISR.JA.086 LAB 1.1. Make incision from bottom of xiphoid process to 1 inch superior to pubis using scalpel LAB 1.2. Reflect any necessary tissue and organs to locate uterus LAB 1.3. Transect uterine tube (Fallopian tube) that connects the ovary at the base of the uterus LAB 1.6. Transect ovarian ligament that connects the ovary and the base of the uterus LAB 1.7. Transect all other attached vessels and tissue REP03 DOCUMENT ID: TISR.JA.086 PAGE 1 OF 1 VERSION DATE: 10/21/13

66 REP04 - Testicle TISR.JA.087 LAB 1.1. Carefully make an incision medially through the scrotum LAB 1.2. Reflect scrotum and dartos muscle away from testis LAB 1.3. Transect spermatic cord from the testis LAB 1.4. Transect all other attached vessels and tissue REP04 DOCUMENT ID: TISR.JA.087 PAGE 1 OF 1 VERSION DATE: 10/21/13

67 SHO01 - Shoulder TISR.JA.088 LAB 1.1. Using a scalpel blade, make a circumferential incision approximately over the mid-shaft of the humerus LAB 1.2. Continue the incision until the blade reaches the bone surface LAB 1.3. Reflect the muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, bisect the humerus LAB 1.5. Using a scalpel blade, make an incision over the mid-shaft of the clavicle LAB 1.6. Continue the incision until the blade reaches the clavicle LAB 1.7. Reflect the skin and muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.8. Using an autopsy saw, bisect the clavicle LAB 1.9. Use a scalpel and make an incision underneath the clavicle in a posterior direction until the exposure of superior border of scapula LAB Dissect tissue away from ribs until anterior portion of scapula is exposed LAB Continue dissection around the inferior portion of the scapula until the entire shoulder is separated LAB Leave skin to sew torso if needed SHO01 DOCUMENT ID: TISR.JA.088 PAGE 1 OF 1 VERSION DATE: 10/21/13

68 SHO02 - Shoulder w/arm TISR.JA.089 LAB 1.1. Using a scalpel blade, make an incision over the mid-shaft of the clavicle LAB 1.2. Continue the incision until the blade reaches the clavicle LAB 1.3. Reflect the skin and muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, bisect the clavicle LAB 1.5. Use a scalpel and make an incision underneath the clavicle in a posterior direction until the exposure of superior border of scapula LAB 1.6. Dissect tissue away from ribs until anterior portion of scapula is exposed LAB 1.7. Continue dissection around the inferior portion of the scapula until the entire shoulder is separated LAB 1.8. Leave skin to sew torso if needed SHO02 DOCUMENT ID: TISR.JA.089 PAGE 1 OF 1 VERSION DATE: 10/21/13

69 SHO03 - Shoulder w/arm w/ribs TISR.JA.090 LAB 1.1. Using a scalpel blade, make an incision over the mid-shaft of the clavicle LAB 1.2. Continue the incision until the blade reaches the clavicle LAB 1.3. Reflect the skin and muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, bisect the clavicle LAB 1.5. Use a scalpel and make an incision underneath the clavicle in a posterior direction until the exposure of superior border of scapula LAB 1.6. Dissect tissue away from ribs until anterior portion of scapula is exposed LAB 1.7. Continue dissection around the inferior portion of the scapula until the entire shoulder is separated LAB 1.8. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 1.9. Make transverse incision through diaphragm LAB Dissect trachea from spine and remaining internals within the pleural cavity LAB Make incision through lower colon and remove internals LAB Wash cavity with water LAB Make an incision on the side of the torso which had SHO01 recovered from the axilla and extend it 3 inches below the 12 th rib LAB Reflect the anterior portion of the skin from the lateral incision so that the ribs and entire sternum are exposed LAB Reflect the posterior portion of the skin from the lateral incision so that the ribs and entire spine to L1 are exposed LAB Separate the contralateral anterior ribs from the sternum so that only the needed ribs remain attached to the sternum LAB Separate the contralateral posterior ribs from the spine so that only the needed ribs remain attached to the spine LAB Locate the vertebral disc between the 12 th Thoracic vertebrae and the 1 st Lumbar vertebrae LAB Make incision thru the disc with scalpel blade LAB Apply small amount of pressure to posterior of spine over incision in disc LAB Cut thru exposed muscle and separate top half of spine from the lower half LAB Pack internal cavity with polysheets SHO03 DOCUMENT ID: TISR.JA.090 PAGE 1 OF 1 VERSION DATE: 10/21/13

70 SHO04 - Shoulder w/elbow TISR.JA.091 LAB 1.1. Using a blade, make a circumferential incision approximately over the mid-shaft of the radius and ulna LAB 1.2. Continue the incision until the blade reaches the bone surface LAB 1.3. Reflect the muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, bisect the radius and ulna LAB 1.5. Using a scalpel blade, make an incision over the mid-shaft of the clavicle LAB 1.6. Continue the incision until the blade reaches the clavicle LAB 1.7. Reflect the skin and muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.8. Using an autopsy saw, bisect the clavicle LAB 1.9. Using an autopsy saw, transect the clavicle LAB Use a scalpel and make an incision underneath the clavicle in a posterior direction until the exposure of superior border of scapula LAB Dissect tissue away from ribs until anterior portion of scapula is exposed LAB Continue dissection around the inferior portion of the scapula until the entire shoulder is separated LAB Leave skin to sew torso if needed SHO04 DOCUMENT ID: TISR.JA.091 PAGE 1 OF 1 VERSION DATE: 10/21/13

71 SHO05 - Shoulder w/clavicle TISR.JA.092 LAB 1.1. Using a scalpel blade, make a circumferential incision approximately over the mid-shaft of the humerus LAB 1.2. Continue the incision until the blade reaches the bone surface LAB 1.3. Reflect the muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Using an autopsy saw, bisect the humerus LAB 1.5. Using a scalpel blade, make an incision over the mid-shaft of the clavicle LAB 1.6. Continue the incision until the blade reaches the clavicle LAB 1.7. Reflect the skin and muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.8. Disarticulate the clavicle from the sternum at the sternoclavicular joint LAB 1.9. Use a scalpel and make an incision underneath the clavicle in a posterior direction until the exposure of superior border of scapula LAB Dissect tissue away from ribs until anterior portion of scapula is exposed LAB Continue dissection around the inferior portion of the scapula until the entire shoulder is separated LAB Leave skin to sew torso if needed SHO05 DOCUMENT ID: TISR.JA.092 PAGE 1 OF 1 VERSION DATE: 10/21/13

72 SHO06 - Shoulder w/arm w/clavicle TISR.JA.093 LAB 1.1. Using a scalpel blade, make an incision over the mid-shaft of the clavicle LAB 1.2. Continue the incision until the blade reaches the clavicle LAB 1.3. Reflect the skin and muscle away from the incision line to expose approximately ½ to ¾ inch of bone surface LAB 1.4. Disarticulate the clavicle from the sternum at the sternoclavicular joint LAB 1.5. Use a scalpel and make an incision underneath the clavicle in a posterior direction until the exposure of superior border of scapula LAB 1.6. Dissect tissue away from ribs until anterior portion of scapula is exposed LAB 1.7. Continue dissection around the inferior portion of the scapula until the entire shoulder is separated SHO06 DOCUMENT ID: TISR.JA.093 PAGE 1 OF 1 VERSION DATE: 10/21/13

73 SPI01 - Spine Whole TISR.JA.094 LAB 1.1. Use a scalpel and make an incision around the posterior of the cephalus just above the ears LAB 1.2. Extend the incision around the posterior of the cephalus to the other ear LAB 1.3. Use a scalpel and make an incision on both sides of the cephalus 1 inch anterior to the ears meeting each incision under the jaw LAB 1.4. Use a scalpel and make a second central midline incision from the underneath the jaw to the umbilicus LAB 1.5. Make an additional incision bilaterally from the umbilicus to the left and right iliac crests LAB 1.6. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.7. Make transverse incision through diaphragm LAB 1.8. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.9. Make incision through lower colon and remove internals LAB Wash cavity with water LAB Use a scalpel and reflect the muscle and connective tissue from the anterior right and left Ilium LAB Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the right and left sacroiliac junctions are completely separated LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Transect any remaining tissues with a scalpel SPI01 DOCUMENT ID: TISR.JA.094 PAGE 1 OF 1 VERSION DATE: 10/21/13

74 SPI02 - Spine Cervical TISR.JA.095 LAB 1.1. Use a scalpel and make an incision around the posterior of the cephalus just above the ears LAB 1.2. Extend the incision around the posterior of the cephalus to the other ear LAB 1.3. Use a scalpel and make an incision on both sides of the cephalus 1 inch anterior to the ears meeting each incision under the jaw LAB 1.4. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.5. Continue the incision until the cervical spine is exposed LAB 1.6. Use a scalpel and make an incision thru the spinal disc that lies between Base and C1 LAB 1.7. Insert an osteotome into the incision line LAB 1.8. Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB 1.9. Re-position the osteotome as needed LAB Transect any remaining tissue attachments with a scalpel LAB Use a scalpel and make an incision into the spinal disc that lies between T2 and T3 LAB Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Re-position the osteotome as needed LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Transect any remaining tissue attachments with a scalpel SPI02 DOCUMENT ID: TISR.JA.095 PAGE 1 OF 1 VERSION DATE: 10/21/13

75 SPI04 - Spine Thoracic TISR.JA.096 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Use a scalpel and make an incision through the disc between C7 and T1 LAB 1.3. Insert an osteotome into the incision line LAB 1.4. Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB 1.5. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.6. Make an additional incision bilaterally from the umbilicus to the left and right iliac crests LAB 1.7. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.8. Make transverse incision through diaphragm LAB 1.9. Dissect trachea from spine and remaining internals within the pleural cavity LAB Make incision through lower colon and remove internals LAB Wash cavity with water LAB Use a scalpel and reflect the muscle and connective tissue from the anterior right and left Ilium LAB Use a scalpel and make an incision thru disc between T12 and L1 LAB Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Use a scalpel to transect any remaining tissue attachments SPI04 DOCUMENT ID: TISR.JA.096 PAGE 1 OF 1 VERSION DATE: 10/21/13

76 SPI05 - Spine Lumbar TISR.JA.097 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.3. Make an additional incision bilaterally from the umbilicus to the left and right iliac crests LAB 1.4. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.5. Make transverse incision through diaphragm LAB 1.6. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.7. Make incision through lower colon and remove internals LAB 1.8. Wash cavity with water LAB 1.9. Use a scalpel and cut thru vertebral disc between T9 and T10 LAB Apply slight pressure to posterior of spine over incision to separate Thoracic spine from the lumbar LAB Remove musculature from anterior ilium using a scalpel or osteotome LAB Locate the sacroiliac joints on either side of the sacrum. Separate these using a scalpel, an osteotome and a mallet LAB Use an autopsy saw to remove the ribs at their attachments to the spine LAB Use a scalpel to transect any remaining tissue attachments SPI05 DOCUMENT ID: TISR.JA.097 PAGE 1 OF 1 VERSION DATE: 3/9/15

77 SPI06 - Spinal Vertebrae TISR.JA.098 LAB 1.1. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.2. Use a scalpel and make a second central midline incision from the laryngeal prominence to the umbilicus LAB 1.3. Make an additional incision bilaterally from the umbilicus to the left and right iliac crests LAB 1.4. Reflect the skin away from the ribs and abdomen with a scalpel LAB 1.5. Make transverse incision through diaphragm LAB 1.6. Dissect trachea from spine and remaining internals within the pleural cavity LAB 1.7. Make incision through lower colon and remove internals LAB 1.8. Wash cavity with water LAB 1.9. Use a scalpel and cut thru vertebral disc as specified in the notes LAB Apply slight pressure to posterior of spine over incision to separate Thoracic spine from the lumbar SPI06 DOCUMENT ID: TISR.JA.098 PAGE 1 OF 1 VERSION DATE: 10/21/13

78 SPI07 - Spine Other TISR.JA.099 LAB 1.1. Consult with an immediate supervisor to determine the procedure for the recovery of a spine that is not listed in the United Tissue Network Standard Operating Procedures Manual DOCUMENT ID: TISR.JA.099 PAGE 1 OF 1 VERSION DATE: 10/21/13

79 TEV01 - Torso Eviscerated TISR.JA.100 LAB 1.1. Follow TISR.JA.042 CEP01 or TISR.JA.043 CEP02 depending on the Tissue List LAB 1.2. Follow TISR.JA.089 SHO02 LAB 1.3. Follow TISR.JA.065 LEG01 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated site TEV01 DOCUMENT ID: TISR.JA.100 PAGE 1 OF 1 VERSION DATE: 10/21/13

80 TEV02 - Torso w/ Proximal Femurs - Eviscerated TISR.JA.101 LAB 1.1. Follow TISR.JA.042 CEP01 or TISR.JA.043 CEP02 depending on the Tissue List LAB 1.2. Follow TISR.JA.089 SHO02 LAB 1.3. Follow TISR.JA.066 LEG02 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites TEV02 DOCUMENT ID: TISR.JA.101 PAGE 1 OF 1 VERSION DATE: 10/21/13

81 TEV03 - Torso w/ Cephalus - Eviscerated TISR.JA.102 LAB 1.1. Follow TISR.JA.089 SHO02 LAB 1.2. Follow TISR.JA.065 LEG01 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites LAB Using the clippers, buzz scalp and facial hair TEV03 DOCUMENT ID: TISR.JA.102 PAGE 1 OF 1 VERSION DATE: 3/1/16

82 TEV04 - Torso w/ Shoulders - Eviscerated TISR.JA.103 LAB 1.1. Follow TISR.JA.042 CEP01 or TISR.JA.043 CEP02 depending on the Tissue List LAB 1.2. Follow TISR.JA.021 ARM02 LAB 1.3. Follow TISR.JA.065 LEG01 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites TEV04 DOCUMENT ID: TISR.JA.103 PAGE 1 OF 1 VERSION DATE: 10/21/13

83 TEV05 - Torso w/ Whole Arms - Eviscerated TISR.JA.104 LAB 1.1. Follow TISR.JA.042 CEP01 or TISR.JA.043 CEP02 depending on the Tissue List LAB 1.2. Follow TISR.JA.065 LEG01 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites TEV05 DOCUMENT ID: TISR.JA.104 PAGE 1 OF 1 VERSION DATE: 10/21/13

84 TEV06 - Torso w/ Cephalus w/ Proximal Femurs - Eviscerated TISR.JA.105 LAB 1.1. Follow TISR.JA.042 CEP01 or TISR.JA.043 CEP02 recovery depending on the Tissue List LAB 1.2. Follow TISR.JA.089 SHO02 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites LAB Using the clippers, buzz scalp and facial hair TEV06 DOCUMENT ID: TISR.JA.105 PAGE 1 OF 1 VERSION DATE: 3/1/16

85 TEV07 - Torso w/cephalus w/proximal Femurs w/shoulders - Eviscerated TISR.JA.106 LAB 1.1. Follow TISR.JA.021 ARM02 LAB 1.2. Follow TISR.JA.066 LEG02 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated leg sites LAB Wrap amputated arm sites with coban LAB Using the clippers, buzz scalp and facial hair TEV07 DOCUMENT ID: TISR.JA.106 PAGE 1 OF 1 VERSION DATE: 3/1/16

86 TEV08 - Torso w/ Cervical Spine - Eviscerated TISR.JA.107 LAB 1.1. Follow TISR.JA.088 SHO01 LAB 1.2. Follow TISR.JA.065 LEG01 LAB 1.3. Use a scalpel and make an incision around the posterior of the cephalus just above the ears LAB 1.4. Extend the incision around the posterior of the cephalus to the other ear LAB 1.5. Use a scalpel and make an incision on both sides of the cephalus 1 inch anterior to the ears meeting each incision under the jaw LAB 1.6. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.7. Continue the incision until the cervical spine is exposed LAB 1.8. Use a scalpel and make an incision thru the spinal disc that lies between Base and C1 LAB 1.9. Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Re-position the osteotome as needed LAB Transect any remaining tissue attachments with a scalpel LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Make transverse incision through diaphragm LAB 2.3. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.4. Make incision through lower colon and remove internals LAB 2.5. Wash cavity with water LAB 2.6. Pack internal cavity with polysheets LAB 2.7. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.8. Sew the anus closed once completely cleaned LAB 2.9. Suture incision made through abdomen LAB Suture amputated sites TEV08 DOCUMENT ID: TISR.JA.107 PAGE 1 OF 1 VERSION DATE: 10/21/13

87 TEV09 - Torso to Toe Tip - Eviscerated TISR.JA.108 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Follow TISR.JA.089 SHO02 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites TEV09 DOCUMENT ID: TISR.JA.108 PAGE 1 OF 1 VERSION DATE: 10/21/13

88 TEV10 - Torso to Toe Tip w/cephalus - Eviscerated TISR.JA.109 LAB 1.1. Follow TISR.JA.089 SHO02 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites LAB Using the clippers, buzz scalp and facial hair TEV10 DOCUMENT ID: TISR.JA.109 PAGE 1 OF 1 VERSION DATE: 3/1/16

89 TEV11 - Torso Complete Minus Cephalus - Eviscerated TISR.JA.110 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Suture amputated sites TEV11 DOCUMENT ID: TISR.JA.110 PAGE 1 OF 1 VERSION DATE: 10/21/13

90 TEV12 - Torso Complete Minus Hands - Eviscerated TISR.JA.111 LAB 1.1. Follow TISR.JA.022 ARM03 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Wrap amputated sites with coban LAB Using the clippers, buzz scalp and facial hair TEV12 DOCUMENT ID: TISR.JA.111 PAGE 1 OF 1 VERSION DATE: 3/1/16

91 TEV13 - Torso Complete Minus Feet - Eviscerated TISR.JA.112 LAB 1.1. Follow TISR.JA.068 LEG04 LAB 2. Evisceration LAB 2.1. Make incision from bottom of xiphoid process to 1inch superior to pubis using a scalpel LAB 2.2. Remove abdominal cavity organs LAB 2.3. Make transverse incision through diaphragm LAB 2.4. Dissect trachea from spine and remaining internals within the pleural cavity LAB 2.5. Make incision through lower colon and remove internals LAB 2.6. Wash cavity with water LAB 2.7. Pack internal cavity with polysheets LAB 2.8. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 2.9. Sew the anus closed once completely cleaned LAB Suture incision made through abdomen LAB Wrap amputated sites with coban LAB Using the clippers, buzz scalp and facial hair TEV13 DOCUMENT ID: TISR.JA.112 PAGE 1 OF 1 VERSION DATE: 3/1/16

92 TIN01 - Torso Intact TISR.JA.113 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Follow TISR.JA.088 SHO01 LAB 1.3. Follow TISR.JA.065 LEG01 LAB 1.4. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.5. Pack the anus with gauze LAB 1.6. Sew the anus closed once completely cleaned LAB 1.7. Suture amputated sites TIN01 DOCUMENT ID: TISR.JA.113 PAGE 1 OF 1 VERSION DATE: 10/21/13

93 TIN02 - Torso w/ Proximal Femurs - Intact TISR.JA.114 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Follow TISR.JA.088 SHO01 LAB 1.3. Follow TISR.JA.066 LEG02 LAB 1.4. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.5. Pack the anus with gauze LAB 1.6. Sew the anus closed once completely cleaned LAB 1.7. Suture amputated sites TIN02 DOCUMENT ID: TISR.JA.114 PAGE 1 OF 1 VERSION DATE: 10/21/13

94 TIN03 - Torso w/ Cephalus - Intact TISR.JA.115 LAB 1.1. Follow TISR.JA.088 SHO01 LAB 1.2. Follow TISR.JA.066 LEG02 LAB 1.3. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.4. Pack the anus with gauze LAB 1.5. Sew the anus closed once completely cleaned LAB 1.6. Suture amputated sites LAB 1.7. Using the clippers, buzz scalp and facial hair TIN03 DOCUMENT ID: TISR.JA.115 PAGE 1 OF 1 VERSION DATE: 3/1/16

95 TIN04 - Torso w/ Shoulders - Intact TISR.JA.116 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Follow TISR.JA.021 ARM 02 LAB 1.3. Follow TISR.JA.066 LEG02 LAB 1.4. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.5. Pack the anus with gauze LAB 1.6. Sew the anus closed once completely cleaned LAB 1.7. Suture leg and cephalus amputated sites LAB 1.8. Wrap arm amputated sites with coban TIN04 DOCUMENT ID: TISR.JA.116 PAGE 1 OF 1 VERSION DATE: 10/21/13

96 TIN05 - Torso w/ Whole Arms - Intact TISR.JA.117 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Follow TISR.JA.065 LEG01 LAB 1.3. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.4. Pack the anus with gauze LAB 1.5. Sew the anus closed once completely cleaned LAB 1.6. Suture amputated sites TIN05 DOCUMENT ID: TISR.JA.117 PAGE 1 OF 1 VERSION DATE: 10/21/13

97 TIN06 - Torso w/cephalus w/proximal Femurs - Intact TISR.JA.118 LAB 1.1. Follow TISR.JA.089 SHO02 LAB 1.2. Follow TISR.JA.066 LEG02 LAB 1.3. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.4. Pack the anus with gauze LAB 1.5. Sew the anus closed once completely cleaned LAB 1.6. Suture amputated sites LAB 1.7. Using the clippers, buzz scalp and facial hair TIN06 DOCUMENT ID: TISR.JA.118 PAGE 1 OF 1 VERSION DATE: 3/1/16

98 TIN07 - Torso w/cephalus w/proximal Femurs w/shoulders - Intact TISR.JA.119 LAB 1.1. Follow TISR.JA.021 ARM02 LAB 1.2. Follow TISR.JA.066 LEG02 LAB 1.3. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.4. Pack the anus with gauze LAB 1.5. Sew the anus closed once completely cleaned LAB 1.6. Suture amputated leg sites LAB 1.7. Wrap amputated arm sites with coban LAB 1.8. Using the clippers, buzz scalp and facial hair TIN07 DOCUMENT ID: TISR.JA.119 PAGE 1 OF 1 VERSION DATE: 3/1/16

99 TIN08 - Torso w/cervical Spine - Intact TISR.JA.120 LAB 1.1. Follow TISR.JA.089 SHO02 LAB 1.2. Follow TISR.JA.065 LEG01 LAB 1.3. Use a scalpel and make an incision around the posterior of the cephalus just above the ears LAB 1.4. Extend the incision around the posterior of the cephalus to the other ear LAB 1.5. Use a scalpel and make an incision on both sides of the cephalus 1 inch anterior to the ears meeting each incision under the jaw LAB 1.6. Use a scalpel and make a circumferential incision around the neck below the line of the laryngeal prominence LAB 1.7. Continue the incision until the cervical spine is exposed LAB 1.8. Use a scalpel and make an incision thru the spinal disc that lies between Base and C1 LAB 1.9. Insert an osteotome into the incision line LAB Use a mallet and strike the osteotome until the disc, spine, and cord are completely separated LAB Re-position the osteotome as needed LAB Transect any remaining tissue attachments with a scalpel LAB Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB Pack the anus with gauze LAB Sew the anus closed once completely cleaned LAB Suture amputated sites TIN08 DOCUMENT ID: TISR.JA.120 PAGE 1 OF 1 VERSION DATE: 10/21/13

100 TIN09 - Torso to Toe Tip - Intact TISR.JA.121 LAB 1.1. Follow TISR.JA.042 CEP01 LAB 1.2. Follow TISR.JA.089 SHO02 LAB 1.3. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.4. Pack the anus with gauze LAB 1.5. Sew the anus closed once completely cleaned LAB 1.6. Suture amputated sites TIN09 DOCUMENT ID: TISR.JA.121 PAGE 1 OF 1 VERSION DATE: 10/21/13

101 TIN10 - Torso to Toe Tip w/cephalus - Intact TISR.JA.122 LAB 1.1. Follow TISR.JA.089 SHO02 LAB 1.2. Perform a bowel prep in which the cadaver is given an enema to clean out the bowels LAB 1.3. Pack the anus with gauze LAB 1.4. Sew the anus closed once completely cleaned. LAB 1.5. Suture amputated sites LAB 1.6. Using the clippers, buzz scalp and facial hair TIN10 DOCUMENT ID: TISR.JA.122 PAGE 1 OF 1 VERSION DATE: 3/1/16