Section 7.3: Restorative Techniques, Suturing, & Waxing

Restorative Techniques, Suturing, & Waxing

Restorative art often requires repairing structural damage caused by trauma, disease, or post-mortem changes. This involves two core practical disciplines: selecting the appropriate suture to close and secure tissues, and applying wax to recreate missing surface structures.

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Pre-Restorative Preparation

Before any suturing or waxing can begin, the underlying tissue must be properly prepared. Failure to prepare the tissue is the most common cause of cosmetic and structural failure.

1. Thorough Embalming: Tissues must be heavily embalmed to ensure preservation and firmness. Embalming fluid should contain a high index of formaldehyde, and in localized trauma areas, hypodermic injection may be required.
2. Chemical Drying (Cauterization): Wax will not adhere to moist tissue. Any area that exhibits leakage, moisture, or raw dermis must be treated with a chemical cauterant, such as phenol or cavity fluid. These chemicals dehydrate the tissue and sear the capillaries.
3. Sealing: Once the tissue is dry, a liquid sealer or collodion is applied to create an impermeable barrier against leakage.

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Suturing Techniques in Restorative Art

Sutures serve different purposes in restorative art: some are designed to close incisions invisibly, others are meant to hold tissues under tension, and one is specifically designed as a structural framework.

1. Intradermal Suture (Hidden Suture)

Used on exposed areas such as the face, neck, and hands where the suture must not be visible.

• Single Intradermal: Uses a single needle and thread. The needle is inserted into the subcutaneous tissue and directed horizontally through the margins of the incision, alternating from one side to the other.
• Double Intradermal: Uses two needles and a single thread. The needles are laced through the subcutaneous margins in opposite directions, similar to lacing a shoe. This provides greater tension control and pulls the margins together very flatly.

2. Worm Suture (Draw / Inversion Suture)

This suture is used to gather in and turn under excess skin margins. It is completely invisible when completed because the stitch folds the skin edges inward. It is excellent for closing incisions on the neck or behind the ear.

3. Baseball Suture

The most common suture used in embalming. It is made by passing the needle from the inner side of the incision to the outer side, repeating this in a continuous spiral. It creates a very tight, leak-proof seal, but leaves a visible ridge. It is used for autopsy incisions, long bone donations, and vascular injection sites.

4. Purse String Suture

A circular suture passed in and out of the margins of a round opening (such as a trocar puncture, aspiration site, or bullet wound). When the ends are pulled tight, the opening is gathered together and closed like a drawstring bag.

5. Basket Weave Suture (Cross-Stitch)

Unlike other sutures, the basket weave is not designed to close a wound. Instead, it is threaded back and forth across a deep wound cavity or excision site, creating a crisscross web of thread. This web acts as an anchor or structural framework to hold wound filler wax in place.

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Classification of Mortuary Waxes

Mortuary waxes are classified by their firmness and adhesive properties. Selecting the correct wax is critical to the longevity of the restoration.

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Wax Application, Modeling, and Texturing

Once the tissue is dry, sealed, and a basket weave suture is placed (for deep wounds), the wax can be applied:

Application Steps

1. Layering: Wax should be applied in layers. Deep cavities are filled first with wound filler wax up to within a quarter-inch of the surface. Medium or soft wax is used for the surface layer.
2. Smoothing: The wax margins must be feathered (blended thin) into the surrounding skin. Placing a small amount of massage cream or mineral oil on the modeling instrument or finger helps smooth the wax surface without sticking.

Texturing the Wax Surface

An untextured wax surface looks flat, shiny, and artificial. The embalmer must recreate the natural texture of human skin:

• Pores: Recreated by gently pressing a stipple brush, a damp lint-free paper towel, or a coarse sponge into the wax.
• Wrinkles (Furrows): Recreated by drawing fine lines into the wax using a toothpick, a dental spatula, or a piece of dental floss pressed lightly onto the surface.
• Peach Fuzz (Lanugo): Can be simulated by blowing a small amount of cosmetic powder over the wax surface before applying cream cosmetics.