In 2009, the Centre for Anatomy and Human Identification started Thiel embalming on a small scale to assess (i) the suitability for our current teaching in which long-lasting dissection courses are key, (ii) the potential for new collaborations and activities, and (iii) the practical implications of changing our embalming method from formalin to Thiel. Twenty six Thiel-embalmed cadavers have been used for dissection by staff and students on a taught MSc course, as a model for clinical and surgical training, and increasingly as a model for evaluation of new medical devices and procedures. Our experiences with dissection were mostly positive especially for teaching the musculoskeletal system. Internal organs handle differently from formalin-fixed organs and dissection manuals need to be adjusted to reflect this. Durability of the cadavers was not an issue, though changes are seen over time due to gradual fluid loss. We have started new collaborations related to postgraduate anatomy teaching and advanced training in surgical and clinical skills. In general, feedback is very positive and demand for cadavers outstrips our current limited supply. Thiel-embalmed cadavers were found to provide a unique opportunity for evaluation of medical products especially in areas where no suitable alternative model is available, and without the complications associated with clinical testing. This has resulted in new collaborations and research projects. As a result Thiel-embalmed cadavers are used for longer and for more activities than formalin cadavers: this requires changes in our procedures and staff roles.

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Formalin had traditionally been used to preserve human material to teach gross anatomy. In 2008 the Centre for Anatomy and Human Identification (CAHID) at the University of Dundee embarked on the use of the Thiel method of embalming. The aim of this pilot study was to assess the difference between formalin-embalmed cadavers (FEC) and Thiel-embalmed cadavers (TEC) used for teaching and surgical training. Three different questionnaires were prepared for data collection from undergraduate and postgraduate students and clinical staff. All undergraduate and postgraduate students as well as clinical staff commented on the appearance of the TEC. There was no overall consensus concerning the use of TEC, some respondents preferred TEC for the entire dissection, some only for certain areas such as the musculoskeletal system. On a technical level TEC were considered less hazardous then FEC by one-third of participants with fewer than 10% regarding TEC as more irritating than FEC. Psychologically, 32.7% of undergraduate students expressed the view that TEC made them feel more uncomfortable compared with FEC because of their life-like appearance. However, 57.1% of undergraduate students encountered the same uncomfortable feelings when viewing both TEC and FEC. The use of Thiel-embalmed cadavers to teach anatomy has an added value, though further research is required over longer periods of time to identify its best usage.

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Working hours of UK trainee doctors have recently been reduced to 48 hours per week, reducing exposure to clinical cases. As such, there is widespread acceptance that trainees need to train in environments other than the ward or operating theatre in order to gain practical skills. Formalin-fixed cadavers demonstrate gross muscle and nerve anatomy but needle insertion under ultrasound guidance is poor. In contrast, a new development in medical simulation is the use of Thiel-embalmed cadavers, developed by Professor Thiel of the University of Graz, Austria, using a novel preservation technique that retains full flexibility of the limbs. Thiel cadavers have been used to successfully simulate laparoscopic surgery, neurosurgery and oral surgery. This paper investigates, for the first time, the application of ultrasound-based regional anaesthesia to the Thiel cadaver by tracing the course of peripheral nerves, injecting local anaesthetic around nerves, and reproducing inadvertent intraneural injection by injecting preservative directly into the nerve. The Thiel cadaver provides good conditions for anaesthetists to simulate regional anaesthetic block techniques using ultrasound.

Human cadaveric tissue is the fundamental substrate for basic anatomic and surgical skills training. A qualitative assessment of the use of human cadavers preserved by Thiel's method for a British Association of Urological Surgeons-approved, advanced laparoscopic renal resection skills training course is described in the present study. Four trainees and four experienced laparoscopic surgeons participated in the course. All participants completed a five-point Likert scale satisfaction questionnaire after their training sessions. The quality of cadaveric tissue and the training session were assessed with particular emphasis placed on the ease of patient positioning, the ease of trocar placement, the preservation of tissue planes, the ease of renal pedicle dissection, and the quality of tissue preservation. All of the participants highly rated the quality of the cadaveric tissue embalmed by Thiel's method (mean scores for quality on the five-point Likert scale were 4.5 and 4.3 by the trainees and experienced laparoscopic surgeons, respectively). All of the steps of laparoscopic renal resection were rated 4.0 or more on the Likert scale by both trainees and faculty members. The initial response rates for using a human cadaver embalmed by Thiel's method as a training tool for laparoscopic nephrectomy showed encouraging results. The performance of a laparoscopic nephrectomy on a human cadaver embalmed by Thiel's method bears close resemblance to real laparoscopic nephrectomy procedures, and thus demonstrates added advantages to the previously reported models.

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The sensory distribution in the dorsum of the hand was investigated in 150 formalin-fixed hands with the aim of outlining the most common innervation pattern of the superficial branch of the radial nerve (SBRN), dorsal branch of the ulnar nerve (DBUN) and the lateral antebrachial cutaneous nerve (LABCN). Although variable, the most common pattern found was SBRN innervation to the dorsal surface of the lateral 2½ digits and DBUN innervation to the dorsal surface of the medial 2½ digits. Dual innervation due to communicating branches or nerves overlapping was found in 41 cases. All-radial supply to the dorsum of the hand was found in ten cases. The LABCN was closely associated, and occasionally overlapped, with the SBRN. There were significant differences in the sensory distribution of the dorsum of the right and left hands of the same cadaver. The sensory distribution in the dorsum of the hand is variable; however, understanding the most common innervation pattern and appreciating the possible variations to this pattern is important to avoid errors in interpretation of conduction velocity studies, misdiagnosis of nerve pathology signs and symptoms and inappropriate treatments.