Int. J. Morphol.

,
34(4):1442-1454, 2016.

Walter Thiel’s Embalming Method. Review of Solutions and

Applications in Different Fields of Biomedical Research

Método de Embalsamamiento de Walther Thiel. Revisión de las Soluciones

y sus Aplicaciones en Diferentes Campos de Investigación Biomédica

Nicolás Ernesto Ottone*,**; Claudia A. Vargas **,***; Ramón Fuentes* & Mariano del Sol**,****

OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and
applications in different fields of biomedical research. Int. J. Morphol., 34(4):1442-1454, 2016.

SUMMARY: Walter Thiel developed the method that enables preservation of the body with natural colors in 1992. It consists in
the application of an intravascular injection formula, and maintaining the corps submerged for a determinate period of time in the
immersion solution in the pool. After immersion, it is possible to maintain the corps in a hermetically sealed container, thus avoiding
dehydration outside the pool. The aim of this work was to review the Thiel method, searching all scientific articles describing this
technique from its development point of view, and application in anatomy and morphology teaching, as well as in clinical and surgical
practice. Most of these studies were carried out in Europe. We used PubMed, Ebsco and Embase databases with the terms “Thiel
cadaver”, “Thiel embalming”, “Thiel embalming method” and we searched for papers that cited Thiel`s work. In comparison with
methods commonly used with high concentrations of formaldehyde, this method lacks the emanation of noxious or irritating gases; gives
the corps important passive joint mobility without stiffness; maintaining color, flexibility and tissue plasticity at a level equivalent to that
of a living body. Furthermore, it allows vascular repletion at the capillary level. All this makes for great advantage over the formalin-
fixed and fresh material. Its multiple uses are applicable in anatomy teaching and research; teaching for undergraduates (prosection and
dissection) and for training in surgical techniques for graduates and specialists (laparoscopies, arthroscopies, endoscopies).

KEY WORDS: Embalming; Dissection; Walter Thiel; Surgical training; Review.

INTRODUCTION

The aim to preserve the body has existed since ancient Among these solutions is the one created in 1992 by
times. This wish was in response to questions of a religious anatomist Walter Thiel. His fixation method involves
nature and the need to allow the deceased the passage to preserving the body with natural colors through intravascular
eternal life. With the beginning of human body studies and injection of a solution and subsequent immersion in a second
although religious rites remained in place, the need arose to solution for a determined amount of time, allowing the
preserve cadavers for prolonged periods of time. Several cadaver to be stored in a sealed container, outside the tank,
centuries passed until the discovery of formaldehyde (18th without preservation fluid. This method of handling the
century), which has been the fixative par excellence until cadaver is more efficient and convenient, and lacks the toxic
today. However, its toxicity and its use which results in or irritating gases due to minimum formaldehyde
increased cadaver stiffness and tissue darkening makes concentrations used in the formula.
dissection and the practice of surgical techniques on the
cadaver difficult. Therefore, in addition to the need to pre- The Thiel embalming method uses, among other
serve bodies with characteristics that approximate the fresh components, 4-chloro-3-methylphenol as well as various
cadaver as much as possible, considerable research has been salts for fixation, boric acid for disinfection, and ethylene
devoted to search for the right solution to reduce and/or glycol for the preservation of tissue plasticity (Thiel, 1992;
substitute the use of formaldehyde. 2002) (Table I).

*
Plastination and Anatomical Techniques Laboratory, Research Center in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile.
**
Doctoral Program in Morphological Sciences, School of Medicine, Universidad de La Frontera, Temuco Chile.
***
Department of Physical Education, School of Education, Universidad de La Frontera, Temuco, Chile.
****
Center of Biomedical Research, Universidad Autónoma de Chile, Chile.

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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

Table I. Basic composition of injection and immersion solutions described by W. Thiel

in 1992.
Solution A Injection Solution Immersion Solution
Boric acid 3 g Solution A 14300 ml Ethylene glycol 10 ml
Ethylene glycol 30 ml Solution B 500 ml F ormaldehyde 2 ml
Ammonium nitrate 20 g Formaldehyde 300 ml S olution B 2 ml
Potassium nitrate 5 g Sodium sulfate 700 g Boric acid 3 g

embalming
Thiel
Hot water 100 ml Ammonium nitrate 10 g

77
Solution B P otassium nitrate 10 g
Ethylene glycol 10 ml S odium sulfate 7 g
4-chloro-3-methylphenol 1 ml Hot water 100 ml

Embase

cadaver
Thiel

369
214

135
78

77
The cadavers are perfused via the femoral or carotid artery with an
intravascular solution containing 14300 mL of solution A, plus 500 mL of

embalming
solution B and the addition of 700 g of sodium sulfite as well as 300 mL

method
Thiel

78
formalin (Table I) for a body weighing 80 kg.

The original study described perfusion of the lungs with additional

solutions using a tracheal tube, the intestine using a gastric tube and the

Thiel embalming
brain through the superior sagittal sinus. These procedures seem to be

20
unnecessary in cadavers used for surgical training courses (Balta et al., 2015a).
Cadavers are stored for approximately 6 months in the immersion solution
that contains 3 % (w/v) boric acid, 10 % (v/v) (mono-) ethylene glycol, 10 %
(v/v) ammonium nitrate, 5 % (w/v) potassium nitrate, 7% (w/v) sodium sulfite,

EBSCO

cadaver
Thiel

140
615
2 % (v/v) formalin and 2 % (v/v) of solution B. After that, the cadavers are

54
23

11

20

61
79
3
kept in zipper polyethylene bags. The cadavers can be used for months or
Table II. Search of Thiel´s technique articles in PubMed, EBSCO and Embase databases.

years (Thiel, 1992, 2002; Balta et al., 2015b). The formalin content of the
fixative is drastically reduced, with a final concentration of 0.8 % of the total embalming
method
Thiel

formula, and thus the odor is reduced (Balta et al., 2015b). 11

The result of the application of the Thiel formula is a non-irritating

and almost odorless product, preserving the color, flexibility and plasticity
embalming

very similar to the living body with ample joint mobility that maintains tissue
Thiel

43

elasticity, apt for training surgical techniques and invasive clinical procedures.

The aim of this work was to review the Thiel embalming method,
identifying authors who developed the original technique, those who modified
PubMed

cadaver
Thiel

192
107

42
64
43

it, and the studies showing the various uses of the body embalmed with this
method in relation to teaching anatomy, morphology, and development of
clinical and surgical abilities and skills. New anesthetic techniques, imaging
and so forth are also examined, noting advantages and drawbacks in the
embalming
method
Thiel

application of this method compared to other fixation and preservation

42

techniques.

METHODOLOGY
Final sele ction of Thiel´s

Repeated ones between

Total found articles

A review of the Thiel method was realized, searching in “Pubmed”,

Database

“Ebsco”, “Embase” where the following terms were used: “Thiel embalming,”
Final selection

“Thiel embalming method”, “Thiel cadaver” also searching all articles that
Repeated

have cited Thiel`s work. This search, conducted between March 21 and April
No Thiel

Total
Terms

Total

4, 2016, yielded 79 articles (Table II), and we added one article not included
ti l

in these databases.
n

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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

Table III. Injection solution by Walther Thiel and other authors (*1. Groscurth, 2001; Wolff et al., 2008; Hunter et al., 2014; Cabello et al., 2014). ** These authors adapted the
The search for scientific articles related to the development of

15800 ml

17000 ml

15800 ml
( aprox.)
Thiel´s technique and its countless applications was carried out using

Total

-
PubMed, EBSCO and Embase databases. Applying the terms "Thiel
embalming," "Thiel embalming method" and "Thiel cadaver" 192, 54

sulfate
and 371 articles from each database were found for a total of 617 articles.

700 g

700 g

700 g

700 g
Sodiu
m

-
From this last number, repeated articles and those that did

INJECTION SOLUTION
not correspond to Thiel´s technique were identified and eliminated and

(for one cadaver)

2100 ml (a)

1500 ml (v)
Formaldeh
thus it was reduced to 43 PubMed articles, 20 EBSCO articles and 79

300m L
300 ml

300 ml
300 ml
yde
Embase articles. A total of 142 articles were gathered. Finally, we
compared these 142 articles and those that repeated were removed,
reaching the final number of 81 articles (Table II).

500 ml (a)
3000 ml
Solution

190 ml
500 ml

500 ml

( v)
B

-
In the search carried out of databases mentioned, and after selecting
a total of 82 articles related to the Thiel embalming method, these were

14300 ml

14300 ml
classified according to subject matter: anesthesia 10 articles, anatomic

Solution

1370 ml
A

-
dissection 10 articles, method explanation 6 articles, animal models 4
articles, education 5 articles, surgical techniques (plastic, laparoscopic,
gastric band surgery) 22, anatomic techniques 8, imaging 8, biomechanics

( aprox.

20000
Total

3000
ml

ml
)
-

-
4, original article by Thiel 2, study of the middle ear 1.

SOLUTION B

methylphen
DESCRIPTION OF THE THIEL METHOD AND ITS VARIANTS

4-chloro-3-

1800 g

1000 g

300 g
300 g

(a;v)
(for n)

1g
ol
In 2011 a survey was conducted in 311 anatomy centers worldwide,
which established that only 11 % of centers regularly use the Thiel

18200 ml

10000 ml
Ethylene
embalming method, and all were European. It confirmed further, that

3000 ml
glycol

10 ml

(a;v)

-
formalin was still the most frequently used fixative for embalming
(Benkhadra et al., 2011a).

5500 ml (v)
13000 ml
75900 ml
( aprox.)

1375 ml
Total

In South America, the Thiel method has been developed in Argen-

(a)

-
-
tina, by the Dissection Team of the Anatomy Chair, at the Faculty of
Medicine at the Universidad de Buenos Aires (Bertone et al., 2011).

6800 ml (a)

1450 ml (v)
63300 ml
1055 ml
100 ml
water

As described initially (Table I), the Thiel method is basically

Hot

-
proportion of Thiel´s formula according to the number of cadavers.

comprised of two types of solutions: intravascular injection and immersion.

In this regard, since the appearance of the Thiel method in 1992, many
authors have reproduced the original technique (Groscurth et al., 2001;
P otassium

420 g (a)

130 g (v)
nitrate

3200 g
530 g

500 g
SOLUTION A

5g

Wolff etal., 2008; Hölzle et al., 2012; Hunter et al., 2014; Cabello et al.,
(for n)

2015; Willaert et al., 2016) and in more recent studies, they have made
modifications to the technique: in compound concentrations, in their
combination and in the creation of solutions (Kerckaert et al., 2008;
m nitrate

1,7 kg (a)

520 g (v)
Ammoniu

12600 g

2000 g
2100 g
20 g

Bertone et al.; Eisma et al., 2013b; Hayashi et al., 2014; Hammer et al.,
2015a) (Tables III and IV). The cadavers are perfused using the internal
saphenous vein (Thiel, 1992; Groscurth et al.) and in case of difficulty
19000 ml
Ethylene

2,5 L (a)
3200 ml

3500 ml

finding it, the femoral or the common carotid artery can be used (Bertone
780 ml
glycol

30 ml

(v)

et al.; Hammer et al., 2015a).

Thiel also describes another series of solutions to inject into the

250 g (a)

80 g (v)
1900 g
Boric

320 g

300 g
acid

3g

body: intrathecal, intratracheal and intrarectal (Thiel, 1992, 2002;

Groscurth; Wolff et al., 2008; Hunter et al.; Cabello et al.). Nevertheless,
not many authors have used them (Bertone et al.; Hammer et al., 2015a).
Hammer et al.
Bertone et al.

al. (2008) (n:

(2011) (n: 1)

(2015) (n: 2)
Thiel (1992;
Solutions

Kerckaert et

Eisma et al.

Thiel (1992) indicates that every solution has to be prepared and used
Authors

2002)*1

immediately, but this is not necessary with the main solution (solution
(2013)

A).
6)

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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.
Table IV. Immersion solution (for n) by Walther Thiel and other authors (*1. Groscurth, 2001; Wolff et al., 2008; Hunter et al., 2014; Cabello et al., 2014). ** These authors adapted

With respect to variations of Thiel´s technique, some authors explained the reason to apply
these modifications. Hammer et al. (2015a), modified the injection site, injecting the femoral artery

1 250000 ml
720000 ml
120000 ml

228000 ml
instead of the external iliac artery, saving work time in the cadaver. Eisma et al. (2013b), use lower
100 ml
water
Hot

formalin concentrations as opposed to the standard formalin concentration (8.9 % vs 37.5%), reducing
the solution toxicity.

Another variation reported was the time the cadaver was kept in the immersion solution. In
105000 g
Sodium

50000 g

20000 g

Thiel’s original technique (1992), the immersion time is six months. However, Bertone et al. kept
sulfate

8300 g
7g

the body submerged for one month; Hammer et al. (2015a) and Eisma et al. (2013b) for two
months; Healy et al. (2015) for two to three months; and Kerckaert et al. described the immersion
of cadavers between four and six weeks.
Potassium

36000 g

10000 g
75000 g
nitrate

None of the authors, who adapt the Thiel´s original solutions, compared the results with
6000 g
10 g

Thiel’s original technique.

Despite variations in the application of Thiel’s original method (Kerckaert et al.; Bertone et
al.; Eisma et al., 2013b; Hayashi et al., 2014; Hammer et al., 2015a) the results in terms of the
Ammonium

1 50000 g

characteristics of the cadavers were similar in all studies; the cadavers were well maintained and
71900 g
12000 g

20000 g
nitrate
10 g

had good color preservation.

The advantages of the Thiel method over embalming with formaldehyde were found to be,
limited exposure to pathogens, less use of inhalable toxic products, a significant reduction in
formaldehyde use. In relation to tissues, the color and texture were similar to the living body,
6000 mg
21600 g
45000 g
3600 g
Boric
acid
3g

maintaining the integrity of the three vessel layers (Odobescu et al., 2014). In terms of joint mobility,
the Thiel-embalmed cadaver presented joint flexibility and muscle elasticity (Hayashi et al., 2014;
Bertone et al.). Compared to fresh cadavers, although they also allow joint mobility to be studied
efficiently with real coloration and minimal modifications to the tissue forms, the time of use is
Solution B

1 4400 ml
3 0000 ml

reduced, with rapid deterioration and advancement of the decaying process in a few hours, with the
2400 ml

190 g
2 ml

ensuing high risk of infections in the individuals handling these cadavers (Hayashi et al., 2016;
Bertone et al.).

Moreover, Thiel-embalmed cadavers can be injected with various types of dyes, resins,
Formaldehyde
the proportion of Thiel´s formula according to the number of cadavers.

natural latex, among others, that enable even the smallest vascular branches (smaller than 1 mm) to
125000 ml
14400 ml
2400 ml

4000 ml

be identified, with the opportunity to visualize the entire vascularization (Hubmer et al., 2004;
2 ml

Bertone et al.; Healey et al., 2015).

The Thiel-embalmed cadavers are preserved for more than a year after removal from the
embalming tank (Healey et al., 2015). Bertone et al. managed a correct preservation of the cadaver
for three years with regular administration of the immersion fluid for hydration, just as Eisma et al.
150000 ml
Ethylene

22000 ml
71900 ml
1200 ml

(2013a) who also reported the various surgical techniques to which cadavers were subject during
glycol
10 ml

the training of specialists. After the three years mentioned, the cadavers were disposed of by
cremation. By contrast, Balta et al. (2015a) carried out a historical review and comparison of
embalming techniques, suggesting that further research is needed on the chemical secreted prior to
cremation of the Thiel-embalmed cadavers. Janczyk et al. (2011), mention that some chemicals
used in the Thiel method are toxic and highly flammable, explosive and extremely dangerous for
Kerckaert et al. (2008) (n: 6)**

Hammer et al. (2015) (n: 2)**

Bertone et al. (2011) (n: 1)**

health and the environment.

Eisma et al. (2013)**
Authors

The Thiel soft-fix embalming method for preserving cadavers with “natural colors” achieves
well preserved organs and tissues, with natural color, consistency, flexibility, plasticity and
Thiel (1992) *1

transparency based on three processes: fixation, disinfection (bactericide) and preservation with
solutions that contain 4-chloro-3-methywhich phenol acting as a fixative, boric acid which acts as
disinfectant and ethylene glycol for the preservation of tissue plasticity, as the basic components
(Thiel, 1992; Groscurth et al.; Thiel, 2002; Kerckaert et al.; Wolff et al., 2008; Bertone et al.;
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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

Hölzle et al.; Eisma et al., 2013b; Hayashi et al., 2014; Verstraete et al. analyzed the elastic modulus,
Hammer et al., 2015a; Healey et al., 2015; Hunter et al.; Ca- concluding that Young's modulus of human tissue is
bello et al.; Willaert et al., 2016). Sodium sulfate and formalin significantly altered in Thiel-embalmed tendons, a key
are added just prior to perfusion. The final formaldehyde determinant for the biomechanical properties, observing an
concentration is less than 0.8 %. Formaldehyde contributes increase in stiffness compared to fresh frozen samples.
antiseptic properties (Hammer et al., 2015a). The salts used
(ammonium nitrate, potassium nitrate, sodium sulfate) absorb Referencing studies by Liao et al. and Verstraete et
the water in the tissues, the nitrates they contain give the al., Hammer et al. (2015b) wrote a letter to the editor
muscles a more reddish color through the action of the mentioning that, to allow a more detailed interpretation of
nitrosomyoglobin that is formed from the muscles themselves the results, it would be useful to know how material slippage
(Janczyk et al.; Hammer et al., 2015a). Thiel (1992) established and the stiffness of the testing machine were determined.
that ethylene glycol is responsible for the haptic properties of They also established the need to add a summary of the Thiel
the tissues. It is a fact that the preservation odor with this method fixative composition, in view of the existence of some
is faint; it is also effective in disinfection and does not release variations, recommending that greater care be taken when
noxious substances into the environment (Verstraete et al., determining that “Thiel-embalmed tissues are sufficiently
2015). Thiel confirmed the disinfection efficacy of the similar to fresh tissues and suitable for many procedures
technique by bacteriologic tests and none of the cadavers and applications” (Liao et al.) on the basis of three donors,
showed mold (Thiel 1992). Kerckaert et al., cited the same. since, as they say very well, “Many other factors influence
the final effect of Thiel embalming” (Verstraete et al.).
Thiel (1992, 2002) described a special solution for brain
fixation: tap water 40 mL, (mono) ethylene glycol 10 mL, For their part, Joy et al. (2015) made a comparative
Isopropyl alcohol 40 mL and Formalin 10 mL. The application quantitative evaluation with Young's modulus of the
of this solution is done with a lumbar puncture needle trough properties of Thiel-preserved tissues using shear wave
the lamina cribosa of the ethmoid bone, to get to the elastography. The result was that the elasticity of the different
subarachnoid space in direction to the Bregma to get the ante- tissues was similar in Thiel soft-embalmed cadavers and li-
rior horn of the lateral ventricle and finally to get to the corpus ving humans. The elasticity was predicted by the embalming
callosum cistern. With this procedure, the solution will reach time and the tissue type, but not by the age at death or gender.
brain and spinal cord. Thiel described that a peristaltic pump In addition, there was a decrease in the mechanical efficiency
may be used for this perfusion that allows a constant flow of of the bone after six months of immersion in the Thiel
the fixation solution (0,17 - 19 mL/min). The softness of the solution (Unger et al., 2010).
brain conservation was fixed by the addition of high
concentrations of formalin. Another study researched the effects of Thiel
embalming on the deep flexor tendons of fingers on cadavers
Kerckaert et al. said that in future studies they will apply versus fresh frozen cadavers and with rat tail tendon fascicles,
Thiel´s techniques for fixation of the central nervous system. because this is a well-established biomechanical model of a
tendon. However, the results showed differences in the
Eljamel et al. (2014) did some imaging studies of Thiel tendons preserved with the Thiel method in collagen fiber
embalmed cadavers with MRI, revealing a good imaging with networks, likely due to the partial denaturation caused by
clear differentiation of white and gray matters, that suggested boric acid. The tendons of Thiel-embalmed cadavers do not
that it was a very good preservation of the brain. realistically represent the biomechanical characteristics of
fresh frozen tendons (Fessel et al., 2011). Wilke et al. (2011)
Benkadra et al. (2011a) and Bertone et al. obtained a compared the biomechanical properties of the spine between
bad brain preservation with Thiel´s method. Probably, because fresh and Thiel-embalmed calf cadavers, concluding that the
they did not use Thiel´s specific brain solution. Thiel fixation maintains the non-linear load deformation but
increases the range of motion. Therefore, they prefer fresh
To prove what Thiel said about the good flexibility and spinal columns for quantitative biomechanical testing since
plasticity preservation in organs and tissues, several authors these maintain physiological conditions. Nevertheless, for
studied the biomechanical properties. Liao et al. (2015) studied preliminary orientation tests, the use of Thiel-preserved
the elastic properties of the ankle tendons and ligaments to cadavers is recommended.
evaluate the deformation rates. The results of this study of
biomechanical traction demonstrated that the elasticity of In other studies, preserved cadaver heads using the
Thiel-embalmed tendons and ligaments increases with the Thiel method have been used to analyze the mechanics of
rate of deformation. the middle ear in humans, with bone conduction, for clinical
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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

Table V. Hayashi et al. (2014) (n: 2)

SOLUTION A SOLUTION B SOLUTION C
4-chloro-3- Boric Potassium
Ethylene glycol Ammonium nitrate Hot water Hot water
methylphenol acid nitrate
66 g 660 ml 2500 g 4000 ml 370 g 620 g 5000 ml
RESERVE SOLUTION
Solution A Solution B Solution C Propylene glycol Hot water
660 ml 4000 ml 5000 ml 3700 ml 3300 ml
FINAL SOLUTION
Reserve solution Sodium sulfate 20% Formaldehyde Morpholine Ethanol Total
16660 ml 800 g 600 ml 300 ml 1300 ml 18860 ml

use in diagnosis and for the manufacture of headsets. Thiel regards to this topic, at Graz University where the
embalming has the advantage of durability, which makes it composition and effect of both new and old conservation
possible to conduct experiments for long periods of time solutions were studied, they noted in 1988: “According to
with reproducible results (Guignard et al., 2013). experimental and practical information, these measures are
enough to safely kill the HIV”.
In reference to disinfection ability, Thiel (1992)
described that for cadaver conservation, the possibility of Since it was considered sufficient to stop the bacte-
infection of conserved material must be considered. That is ria increase to prevent the bacterial decomposition effect in
why he determined the bacteriological effects of conservation the cadaver, blood cultures in Staphylococcus and
solutions through qualitative experiments from suspension Pseudomonas under the inactivation substance CSL + 3 %
culture, according to DGHM (Deutsche Gesellschaft für Tween 80 + 3 % Saponin + 0,1 % Cystein + 0,1 % Histidin
Hygiene und Mikrobiologie) standards to prove and assess were made. For cadaver infusion dissolution diluted at 7.5
the disinfectant effect of formula components. The utilized % in Staphylococcus an increase was not detected. Neither
bacteria were: Staphylococcus aureus, Pseudomonas was an increase detected in 3 out of 4 samples of
aeruginosa and Mycobacterium tuberculosum. Thiel´s Pseudomonas. The viscera dissolution 1989 did not show
conservation solutions were compared to a solution of phenol either Pseudomonas or Staphylococcus increase (Thiel,
5 % and a solution of formalin 5%. Notably, the infusion 1992).
solution of the cadavers 1989 and viscera solution 1989 did
not show major differences. On the other hand, phenol The blood culture with “phenol” dissolution at 5 %
solution 5 % on Pseudomona effect, was very similar to showed similar results, while the results with formalin
viscera solution 1989, and did not differ either with infusion dissolution at 5 % show effects on both bacteria, down to a
solution 1989. All germs were eliminated after five minutes dissolution of 2.5 %. This shows that formalin dissolution
of being diluted at 75 %. With formalin solution, results with at 5 % has better inhibition results in comparison with phenol
or without serum were much worse. In its non-diluted state it dissolution at 5 % but with worse disinfection results (Thiel,
required 60 minutes to eliminate Staphylococcus and 1992).
Mycobacterium and when diluted at 50 % it took 6 hours.
Nevertheless, viscera solution diluted at 50 % killed all bacte- Normally, in this injection procedure, conservation
ria after 5 minutes. Even with immersion solution 1986, which liquid equivalent to 1⁄4 of the cadaver’s weight is added;
is not as strong, the results were far better in its non-diluted considering that it is distributed evenly, a concentration of
state than with formalin solution at 5 %. This clearly shows 20 % of conservation liquid should be detected. Just 1/3 of
that Thiel´s conservation solutions have strong disinfection this concentration is enough to stop the bacteria increase, so
powers, however it would be incorrect to state that cadavers after the injection solution, the cadaver should be safe from
remain germ-free after long periods of conservation. bacterial decomposition effects (Thiel, 1992).
Mugrowsky (1935, cited by Thiel, 1992), was able to
demonstrate that after conserving cadavers in formalin and The immersion solution without diluting it has a high
phenol, numerous aerobic and anaerobic bacteria survived. safety factor to obtain a great cadaver conservation. With
the immersion solution diluted at 90 % Staphylococcus
It was determined that bacterial infections in aureus is killed in 10 minutes, Pseudomonas aeruginosa is
dissection rooms did not have importance, but doubts remain eliminated in 5 minutes and Mycobacterium tuberculosum
whether AIDS can be excluded from these conclusions. In in 15 minutes (Thiel, 1992).
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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

The drawbacks of the Thiel method were primarily be subjected to daily sessions of at least 5 hours of
the high costs of the required materials and assembly. In dissection without difficulties.
addition, it did not allow identification of the thrombogenic
potential in the practice of vascular sutures (Odobescu et The lumbar sympathetic trunk has been investigated
al., 2014). The preparations had to be preserved in for the identification of anatomical reference points through
hermetically sealed bags between 0° and 6 °C to avoid topographical studies correlated with images to locate its block
mummification (Healey et al., 2015). Bertone et al. also point (Grechenig et al.). In addition, the posterior branch of
kept the cadavers in hermetically sealed bags, but at room the spinal nerve has been studied in relation to epidural
temperature (20º C), although constantly controlling the anesthesia procedure (Saito et al., 2006). Feigl et al. (2011;
dehydration of the body by regularly submerging it in the 2013a) studied spondylopathies, their influence on the
immersion tank. The appearance of blisters and blemishes retroperitoneal spaces in the lumbar sympathetic trunk and
can occur when exposed to the air for prolonged periods. their impact on the distribution of local anesthesia.
Occasionally, due to causes unknown, the organs can dis-
play a gelatinous consistency (Benkhadra et al., 2011a). Several authors have determined the minimum
volume of anesthetic product for application in three
Histological and morphological studies have been procedures: local anesthesia during breast surgery (Guay &
conducted comparing muscle fibers and tendons in fresh Grabs, 2011), ultrasound-guided application (Desroches et
frozen cadavers embalmed with the Thiel method and with al., 2013), and the stellate ganglion block (Feigl et al.,
formalin, trying to identify anomalies in the tissue that 2007a).
explain the mobility of Thiel-embalmed cadavers. Staining
was also used to visualize collagen and keratin. The collagen Studies have been done on a supraomohyoid plexus
structure that forms the base of the muscle structure was block to avoid complications or collateral effects on other
preserved. The muscle fibers appeared as if they had been nerves (Feigl et al., 2006) and the spread of local anesthetic
cut or ground, but were contained in a collagen sheath that to block peripheral nerves (Munirama et al., 2012). For their
stays intact, thereby preserving the general shape of the part, Feigl et al. (2013b), identified a simple orientation mark
muscle. It is considered that boric acid is responsible for the to carry out the vertical obturator nerve block. In 2014, Feigl
damage observed (Benkhadra et al., 2011b). There is also et al., evaluated the anatomical distribution of the nerves
less preservation of the histological characteristics, which and its relation to the lumbar plexus to avoid the occurrence
would make using these cadavers for this type of research of interference complications during the block. Benkhadra
difficult (Hayashi et al., 2016). et al. (2012), explained the possible failures during the
ultrasound-guided infraclavicular nerve block. In addition,
Various articles described Thiel´s method comparative studies have been done between Thield-
applications. Thiel-embalmed cadavers have been used embalmed and fresh cadavers for training in the new
to carry out morphometric studies of anatomical muscle ultrasound-guided anesthetic technique in the cervical region
variations (Pichler et al., 2005; 2007), insertions (Benkhadra et al., 2009).
(Grechenig et al., 2000), perforating vessels (Kappler et
al., 2005), that have clinical implications in reconstructive De Crop et al. (2012), studied the correlation between
surgery, repairs and reinforcement of tendons, and the physical and clinical image of the thorax x-ray in Thiel-
prophylaxis. Thanks to the Thiel technique, vessel embalmed cadavers using insufflation of the lungs while the
diameters are very well preserved (Anderhuber, 2005). image was being taken to simulate the pulmonary anatomy
Anatomical studies have been conducted to implement view on the thorax x-ray.
new, standardized, non-invasive techniques to find certain
anatomical structures in order to reduce the rate of injury Sikora et al. (2015) used samples of the anterior wall
or paralysis during osteosynthesis surgery (Lim et al., of the vagina from patients who had had a hysterectomy,
2012). Hubmer et al. carried out dissection work and an which were preserved in one of four ways: i) in cold, ii)
analysis of the use of the term “recurrent” in the recurrent fresh without fixation, iii) with formaldehyde, and iv) with
branch of the posterior interosseous artery of the distal Thiel solution, to demonstrate the potential of multiphoton
part of the forearm. microscopy in the study and 3D analysis of the extracellular
matrix of the pelvic organs, in which they detected collagen
Some anatomy centers have indicated that the and elastin, for later comparison with standard histological
cadavers are not suitable for dissections lasting several methods. The authors found no differences in collagen and
hours. Bertone et al., however, stated that when cadavers elastin volumes when comparing the samples from the four
are well hydrated with the immersion solution, they can groups.
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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

Karakitsios et al. (2014a; 2014b) conducted studies been used as a training method for regional anesthesia, as
to estimate the value of proton resonance frequency (PRF), they present almost ideal conditions for the practice of this
as a preclinical model, for treatment with MR- procedure (Feigl et al., 2007a; 2007b).
guided focused ultrasound in human and bovine liver and
porcine muscle. The PRF coefficient values measured in the Results were published of a survey administered to
Thiel-embalmed tissue were higher than for the fresh tissue; undergraduate and graduate anatomy students on the
these results can be explained by the chemical composition experience of working with Thiel- and formalin-embalmed
of Thiel’s fluid and electrical conductivity. Another study cadavers (Balta et al., 2015a). In the results students found
reported that the PRF in the focused ultrasound machine that the Thiel solution was less irritating than formalin,
must be calibrated in order to apply it in Thiel-embalmed raising concerns about the preservation of the nervous system
tissues. Gueorguieva et al. (2014) identified signal and and the difference in appearance of Thiel-embalmed cadavers
contrast loss in clinical MRI sequence images due to high and the images in the texts. Thus, the authors proposed that
conductivity of fluids from the Thiel method. new books and manuals on dissection be produced. They
demonstrated that surgical training has been successful in
Using elastography, changes in the muscle module almost all areas using Thiel-embalmed cadavers. The
section with, and without the tissues that cover it (skin and appearance similar to the living body increases the risk of
epimysium) were examined. The short muscle module emotional and psychological impact on students after their
decreased significantly by 50 % after the skin was eliminated first dissection session. It is possible to avoid this by
(Yoshitake et al., 2016). Ando et al. (2014) analyzed the preparing the students before their first encounter with Thiel-
validity of estimating fascicle length in the vastus lateralis embalmed cadavers. According to Bertone et al., at no time
and intermedius of the quadriceps by ecography, concluding has this been proven beyond the normal reaction of certain
that quality of echographic images of Thiel-embalmed students in front of a cadaver, a situation that also occurred
cadavers is equivalent to the quality of images obtained from with formalin-embalmed cadavers.
living human beings.
One article presented the courses given at the
Eljamel et al. (2014) suggest that long-term use of University of Switzerland for the management of the new
these cadavers (up to 15 months) makes the Thiel embalmed Thiel soft-fix embalming technique and construction of
cadaver an excellent model for any other computer-assisted models that can be used for training in the microsurgery of
image-guided, minimally-invasive neurosurgery for training, paranasal sinuses, rhinoplasty and facial plastic surgery,
such as DBS insertion. They consider that Thiel embalmed surgery of the temporal bone (Groscurth et al.; Feigl et al.,
cadavers can be used for developing and testing various 2008), neurosurgery of the middle and posterior cranial fossa,
stereotactic functional neurosurgical procedures endoscopic surgery of the abdomen and pelvis, interventional
neuroradiology, and other techniques. Through these
Kerckaert et al. reported the results of the creation of changes, knowledge of the macroscopic anatomy is improved
the Endogent center, a center for anatomy and invasive as an essential topic for surgical training in this specialization
techniques at the University of Ghent, Belgium, publishing (Groscurth et al.). An analysis of the usefulness of cadavers
their work experiences and uses of the Thiel embalming in anatomy education takes into account the importance of
technique. The group that founded the center received cadavers, considered “silent teachers”, as they teach things
specialist training at the University of Fribourg, Switzerland that books or 3D software cannot, such as the anatomical
to learn this technique, which maintains the flexibility, variability between individuals, the effect of diseases or
plasticity and color of the cadavers and organs like a living lifestyle on the body and the different textures and behavior
person, with movable joints, the only difference being the of tissues (Eisma & Wilkinson, 2014).
absence of blood flow. They used the Thiel method for its
subsequent use in education and surgical specialization courses The use of conventional embalming techniques with
for medical professionals in various techniques and procedures. formalin presents an important limitation in terms of tissue
texture (stiffer), odor, durability, as well as the impossibility
Expert anesthetists executed ventilation maneuvers of creating the pneumoperitoneum in formalin-embalmed
with mask and tracheal intubation by direct laryngoscopy cadavers, and thus the difficulty of undertaking endoscopic
using Thiel-embalmed cadavers and mannequins, concluding surgical techniques (Healey et al., 2015; Feigl et al., 2013b;
that the Thiel-embalmed cadavers were more suitable for Liao et al.). In this review, a large amount of literature was
the ventilation with mask and provided a more realistic found that proposes the use of the Thiel-embalmed cadaver
atmosphere for the laryngoscopy and tracheal intubation than as a simulator to replicate surgical techniques and the training
the mannequins (Szucs et al., 2016). In addition, they have of surgeons. This is due to the preservation of real
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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

characteristics and the easy manipulation that such cadavers model to achieve reperfusion of the porcine pulmonary
present (Bertone et al.; Eisma & Wilkinson; Healey et al., vascular system using an injector pump, by means of which
2015). This way, the use of Thiel-embalmed cadavers has they introduced paraffin perliquidum into the pig’s vascular
extended to various areas of surgery, particularly urological system. They were able to determine that the paraffin
surgery (Healey et al., 2015), thyroidectomies (Eisma et al., perliquidum was suitable to reproduce reperfusion of the
2011), cricothyroidotomies (Benkhadra et al., 2008), liver porcine pulmonary vascular system; however, found that the
surgery simulations (Eisma et al., 2013a), arthroplasty small vessels were broken in the process. In another study,
(Windisch et al., 2001; Kamei et al., 2013), artery sutures Willaert et al. (2015) developed a model similar to the
(Odobescu et al., 2014; 2015), peripheral nerve repair (Matzi previous one to reproduce renal circulation. Later, Willaert
et al., 2015), flap surgeries (Hassan et al., 2014a; Wolff et et al. (2016) also produced another animal model for porcine
al., 2014), neurosurgery (Schwalenberg et al., 2010), anasto- vascular reperfusion that adequately reproduced the blood
mosis techniques (Hassan et al., 2014b) and their comparison flow, reaching the vessels of the small intestine, providing
with animal models. Skills development in the area of real coloration of the serosa and mucosa as well as the
angiology and laparoscopy are an additional advantage, remaining organs, achieving a more realistic reperfusion of
several studies indicating the possibility of producing a the kidney with preservation of the anatomy. These
pneumoperitoneum in the patient with the aim of accurately researchers used methylene blue to identify the scope of the
recreating abdominal laparoscopic surgery (Giger et al., artificially produced reperfusion, and were able to prove that
2008; Slieker et al., 2012) at kidney level (Prasad Rai et al., Thiel’s technique is a low-viscosity solution, that passes
2012; Ubee et al., 2014; Rai et al., 2015). Thus, it has been easily through the capillary walls. Similarly, among some
proven that the preservation of anatomical characteristics in of the limitations raised by this study was the accumulation
Thiel-embalmed cadavers is adequate and allows for the of the incorporated liquid, making it difficult to visualize
realistic recreation of surgery. the anatomical structures and their reperfusion.

Studies with Thiel-embalmed cadaver faces were Hassan et al. (2015) made a comparative study of
conducted for cosmetic purposes, determining that the filling surgical simulations for the repair of zone II flexor tendons
of the premaxillary space is an opportunity to make discrete in Thiel-embalmed human and porcine cadavers. They also
corrections of the philtrum, in addition to having a better compared them to formalin-embalmed cadavers. They
filling for superficial injections (Pilsl et al., 2014). Okada et showed the benefits of Thiel-embalmed cadavers in terms
al. (2012) reported using Thiel-embalmed cadavers for of better tissue flexibility, which allowed a correct surgical
preoperative assessments and confirmed their usefulness, repair of the tendon, preserving the anatomy compared to
especially for the prevention of complications, or in the formalin-embalmed cadavers and porcine models, with the
evaluation of surgical approaches. They concluded that Thiel- latter being the most frequently used in surgical technique
embalmed cadavers have many advantages over cadavers classes due to their greater availability. Thus, the superior
preserved with other methods and that they would also be usefulness of Thiel-embalmed cadavers for surgical practice
useful for the development of new surgical implements or was demonstrated.
for the evaluation of a surgeon’s abilities.

Holzle et al. (2012) used Thiel’s technique to preser- CONCLUSIONS

ve cadavers destined for education and training courses in
oral surgery and implantology through the positioning of
dental implants in cadavers. This is the only study that Walter Thiel’s method of fixation and preservation
applied Thiel’s solution for such surgical training. The of cadavers with “natural colors” is based on three processes:
differences with respect to the animal models lie in certain fixation, disinfection, preservation with solutions that contain
differences in the morphology of the bone and teeth 4-chloro-3-methylphenol, potassium nitrate, ammonium
compared to the human, and the absence of resistance in the nitrate, sodium sulfite, boric acid and monoethylene glycol
virtual models when performing the procedure. The as basic components. Thiel´s original and complete technique
advantages of animal and virtual models, on the other hand, is complex in both its preparation and application in cadavers,
lie in their reusability, which is not the case with a human nevertheless, this technique enables a prolonged
cadaver. preservation, maintaining the color, texture, plasticity and
flexibility, similar to a fresh specimen. While using this
Thiel’s technique has also been applied to animals, method, storage does not require the use of tanks except for
mainly to produce animal models for the training of various rehydration. In addition, it allows the injection of vessels
surgical techniques. Willaert et al. (2014) created an animal and canaliculi up to the thinnest branches.
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 OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Walter Thiel’s embalming method. Review of solutions and applications in different fields of biomedical research.
Int. J. Morphol., 34(4):1442-1454, 2016.

All these characteristics that Thiel-embalmed tual models which, though they aid in developing skills,
cadavers present, make possible their use with great do not have the same value of incorporating knowledge,
advantage over formalin-embalmed cadavers, and even as has the practice on a real human model.
over fresh material due to the simplicity of their handling,
reduced toxicity and prolonged duration. Their multiple Walter Thiel’s technique of preserving the body in
uses are applicable in morphological research for the natural colors is a valuable contribution to the field of
purpose of undergraduate and graduate teaching, in cadaver preservation and a breakthrough in the elimination
addition to training in specialized surgical techniques. of formaldehyde as the only fixative and preservative
method, presenting a number of advantages that render it
When analyzing the literature, the advantage of the first choice, when implementing a technique that is
working directly on a human body is noteworthy, useful in education as well as research and surgical
exceeding the possibilities of doing so on animal or vir- training.

OTTONE, N. E.; VARGAS, C. A.; FUENTES, R. & DEL SOL, M. Método de embalsamamiento de Walther Thiel. Revisión de las
soluciones y sus aplicaciones en diferentes campos de investigación biomédica. Int. J. Morphol., 34(4):1442-1454, 2016.

RESUMEN: En 1992, Walter Thiel desarrolló el método que permite la preservación del cuerpo con colores naturales. Consiste
en la aplicación de una fórmula de inyección intravascular y el mantenimiento del cuerpo sumergido en pileta, en una solución de
inmersión específica, durante un período determinado de tiempo. Después de la inmersión, es posible mantener el cuerpo en un recipien-
te herméticamente sellado, evitando así la pérdida del líquido fijador, fuera de la pileta. El objetivo de este trabajo fue revisar el método
de Thiel, buscando todos los artículos científicos que describen esta técnica desde el punto de vista de su desarrollo, y su aplicación en la
enseñanza de la anatomía y morfología, así como en la práctica clínica y quirúrgica. La mayoría de estos estudios se realizaron en
Europa. Utilizamos las bases de datos PubMed, Ebsco y Embase con los términos "Thiel cadaver", "Thiel embalsamamiento", “método
de embalsamamiento de Thiel" y se buscaron los documentos que citan el trabajo de Thiel. En comparación con los métodos comúnmen-
te utilizados con altas concentraciones de formaldehído, este método carece de emanación de gases nocivos o irritantes; Da al cuerpo una
movilidad articular pasiva importante sin rigidez; Manteniendo el color, la flexibilidad y la plasticidad del tejido a un nivel equivalente
al de un cuerpo vivo. Además, permite la repleción vascular a nivel capilar. Todo esto hace una gran ventaja sobre el material fijado con
formalina y fresco. Sus usos múltiples son aplicables en la enseñanza y la investigación de la anatomía; (prosección y disección) y para
la formación en técnicas quirúrgicas para graduados y especialistas (laparoscopias, artroscopias, endoscopias).

PALABRAS CLAVE: Embalsamamiento; Disección; Walter Thiel; Entrenamiento quirúrgico; Revisión.

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Unger, S.; Blauth, M. & Schmoelz, W. Effects of three different

preservation methods on the mechanical properties of human Received: 16-08-2016
and bovine cortical bone. Bone, 47(6):1048-53, 2010. Accepted: 22-09-2016

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