journal article·2026-02-11Open access

Revitalizing the Silent Teacher: Cutting-Edge Techniques for High-Fidelity Cadaveric Anatomy

Salvatore Pezzino, Giuseppe Angelico, Tonia Luca, Caterina Crescimanno, Mariacarla Castorina, Stefano Puleo, Sergio Castorina

Applied Sciences· Volume 16· Issue 4

Abstract

Cadaveric preservation is fundamental to medical education, research, and surgical training, offering unmatched understanding of human anatomy and tissue dynamics. Although formalin fixation facilitates extended specimen preservation, its toxicity, tissue rigidity, and disruption of molecular analysis have prompted the creation of safer, more biologically representative alternatives. This review delineates the progression of cadaveric preservation, spanning from classical formaldehyde-based techniques through transitional low-toxicity chemical approaches to emerging formaldehyde-free methodologies. We assess the composition, benefits, and drawbacks of each technique, emphasizing the integration with machine learning-guided perfusion, nanotechnology-enhanced polymers, and hybrid approaches that combine digital imaging, 3D scaffolds, and automated monitoring. We propose a decision-making framework that integrates preservation decisions with instructional goals, surgical simulation needs, and research priorities, while adhering to ethical and environmental standards. This thorough analysis combines classic and innovative methodologies to provide practical suggestions for institutions aiming to enhance cadaveric resources for future medical professionals.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Anatomy and Medical Technology · Surgical Simulation and Training · Biomedical and Engineering Education

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy

Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy

Mediterranean Foundation “GB Morgagni”, 95125 Catania, Italy

References (100+)

Show source-provided references
1. The Italian Law on Body Donation: A Position Paper of the Italian College of Anatomists10.1016/j.aanat.2021.151761 ↗
2. The Use and Effectiveness of Cadaveric Workshops in Higher Surgical Training: A Systematic Review10.1308/147870811X582954 ↗
3. Post-Mortem Pedagogy: A Brief History of the Practice of Anatomical Dissection10.5041/RMMJ.10423 ↗
4. Human Cadaveric Dissection: A Historical Account from Ancient Greece to the Modern Era10.5115/acb.2015.48.3.153 ↗
5. Human Body Preservation—Old and New Techniques10.1111/joa.12160 ↗
6. Formalin Use in Anatomical and Histological Science in the 19th and 20th Centuries
7. Formaldehyde Carcinogenicity Research: 30 Years and Counting for Mode of Action, Epidemiology, and Cancer Risk Assessment10.1177/0192623312466459 ↗
8. Glyoxal Acid-Free (GAF) Histological Fixative Is a Suitable Alternative to Formalin: Results from an Open-Label Comparative Non-Inferiority Study10.1007/s00428-023-03692-6 ↗
9. Rethinking Tissue Preservation: A Review of Non-Toxic and Environmentally Sustainable Fixatives10.1016/j.anndiagpath.2025.152500 ↗
10. Human Body Preservation—Old Anatomical Techniques for New Medical Challenges
11. A New Epoxy for Plastination: Feasibility and Applicability Analysis of the Conservation of Biological Tissues10.1590/1414-431x2025e14839 ↗
12. Effectiveness of Different Combinations of Phenoxetol and Formaldehyde on Preservation of Histological Features in Human Cadaveric Tissues10.1016/j.mjafi.2023.07.001 ↗
13. Evaluation of Modified Thiel Soft-Embalmed Cadavers as a Novel Teaching Model for Musculoskeletal Ultrasound and Anatomy among Rehabilitation Medicine Residents10.47895/amp.v57i10.7150 ↗
14. Cryopreservation Method for Preventing Freeze-Fracture of Small Muscle Samples10.21769/BioProtoc.5145 ↗
15. New Approaches to Cryopreservation of Cells, Tissues, and Organs10.1159/000499453 ↗
16. Signorelli, F., Rastegar, V., Palermo, M., Laino, D., Zeoli, F., and Visocchi, M. (2025). Long-Term Preservation of Human Head and Neck Specimens for Neurosurgical Training: A Technical Note. Brain Sci., 15.10.3390/brainsci15091016 ↗
17. A Multispecialty Evaluation of Thiel Cadavers for Surgical Training10.1007/s00268-016-3868-4 ↗
18. 43 Digital Human Project: 3D Photogrammetry for Human Cadaveric Pelvic Specimens: An Innovation in Colorectal Anatomical Education10.1093/bjs/znab135 ↗
19. Hybrid Computed Tomography and Magnetic Resonance Imaging 3D Printed Models for Neurosurgery Planning10.21037/atm.2019.10.109 ↗
20. Pirri, C., Stecco, C., Porzionato, A., Boscolo-Berto, R., Fortelny, R.H., Macchi, V., Konschake, M., Merigliano, S., and De Caro, R. (2021). Forensic Implications of Anatomical Education and Surgical Training With Cadavers. Front. Surg., 8.10.3389/fsurg.2021.641581 ↗
21. Berrino, E., Annaratone, L., Miglio, U., Maldi, E., Piccinelli, C., Peano, E., Balmativola, D., Cassoni, P., Pisacane, A., and Sarotto, I. (2020). Cold Formalin Fixation Guarantees DNA Integrity in Formalin Fixed Paraffin Embedded Tissues: Premises for a Better Quality of Diagnostic and Experimental Pathology with a Specific Impact on Breast Cancer. Front. Oncol., 10.10.3389/fonc.2020.00173 ↗
22. Mass Spectrometry Reveals the Chemistry of Formaldehyde Cross-Linking in Structured Proteins10.1038/s41467-020-16935-w ↗
23. Formaldehyde Crosslinking: A Tool for the Study of Chromatin Complexes*10.1074/jbc.R115.651679 ↗
24. How Formaldehyde Reacts with Amino Acids10.1038/s42004-019-0224-2 ↗
25. Modeling Formalin Fixation and Histological Processing with Ribonuclease A: Effects of Ethanol Dehydration on Reversal of Formaldehyde Cross-Links10.1038/labinvest.2008.43 ↗
26. What Are the DNA Lesions Underlying Formaldehyde Toxicity?10.1016/j.dnarep.2024.103667 ↗
27. Structural Characterization of Formaldehyde-Induced Cross-Links Between Amino Acids and Deoxynucleosides and Their Oligomers10.1021/ja908282f ↗
28. Effect of Fixatives and Tissue Processing on the Content and Integrity of Nucleic Acids10.1016/S0002-9440(10)64472-0 ↗
29. Effects of Different Cadaver Preservation Methods on Muscles and Tendons: A Morphometric, Biomechanical and Histological Study10.1007/s12565-019-00508-z ↗
30. Frigon, E.-M., Dadar, M., Boire, D., and Maranzano, J. (2022). Antigenicity Is Preserved with Fixative Solutions Used in Human Gross Anatomy: A Mice Brain Immunohistochemistry Study. Front. Neuroanat., 16.10.3389/fnana.2022.957358 ↗
31. Saturated Salt Solution Method: A Useful Cadaver Embalming for Surgical Skills Training10.1097/MD.0000000000000196 ↗
32. National Toxicology Program (2026, February 06). 15th Report on Carcinogens. National Institute of Environmental Health Sciences, Available online: https://ntp.niehs.nih.gov/research/assessments/cancer/roc.
33. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2006). Formaldehyde, 2-Butoxyethanol and 1-Tert-Butoxypropan-2-Ol. IARC Monogr. Eval. Carcinog. Risks Hum., 88, 1–478.
34. (2026, February 06). 1910.1048-Formaldehyde
35. Occupational Safety and Health Administration, U.S. Department of Labor: Washington, DC, USA, 1987, Available online: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1048.
36. American Conference of Governmental Industrial Hygienists (2026, February 06). FORMALDEHYDE. Available online: https://www.acgih.org/formaldehyde-2/.
37. CDC (2026, February 06). NIOSH Pocket Guide to Chemical Hazards. Formaldehyde, Available online: https://www.cdc.gov/niosh/npg/npgd0293.html.
38. Contributions of the Thiel’s Method in Teaching and Researching Anatomy10.1016/j.morpho.2021.11.001 ↗
39. Flexibility of Thiel’s Embalmed Cadavers: The Explanation Is Probably in the Muscles10.1007/s00276-010-0703-8 ↗
40. Clinical Anatomy Applications of Thiel-Embalmed Cadavers in Minimally Invasive Surgical Training
41. Thirty Years of Thiel Embalming—A Systematic Review on Its Utility in Medical Research10.1002/ca.23936 ↗
42. Preparation of Soft Embalmed Cadavers by the Modified Thiel Embalming Technique for Surgical Skill Training and Development of a Universal Quantitative Scoring System to Assess the Suitability of Soft Embalmed Cadavers for Such Training Purposes
43. The preservation of the whole corpse with natural color10.1016/S0940-9602(11)80346-8 ↗
44. Supplement to the conservation of an entire cadaver according to W. Thiel10.1016/S0940-9602(02)80121-2 ↗
45. From Formalin to Thiel Embalming: What Changes? One Anatomy Department’s Experiences10.1002/ca.22222 ↗
46. Thiel Embalming: Quantifying Histological Changes in Skeletal Muscle and Tendon and Investigating the Role of Boric Acid10.1002/ca.23491 ↗
47. Use of Thiel-Embalmed Cadavers in Urology Training and Their Ability to Retain Real-Life Anatomy: A Systematic Review10.1111/ans.18436 ↗
48. Surgical Training in Extraperitoneal Laparoscopic Para-Aortic Lymphadenectomy for the Treatment of Gynecological Cancer Using a Thiel-Embalmed Cadaver10.3892/ol.2024.14422 ↗
49. Learning Anatomy through Thiel- vs. Formalin-Embalmed Cadavers: Student Perceptions of Embalming Methods and Effect on Functional Anatomy Knowledge10.1002/ase.1715 ↗
50. The Advantages of Modified Thiel Technique in Head and Neck Surgical Anatomy Teaching10.1007/s00276-022-02895-x ↗
51. Evaluation of the Optimal Approach for Endoscopic Neck Dissection Using Thiel Cadavers10.1016/j.anl.2025.09.003 ↗
52. Thiel Embalming in Neonates: Methodology and Benefits in Medical Training10.1007/s12565-022-00650-1 ↗
53. Randomized Trial Comparing the Spread of Retrolaminar Block with the Combination of Erector Spinae Block and Retrolaminar Block in Soft Embalmed Thiel Cadavers10.1136/rapm-2022-103474 ↗
54. Macluskey, M., Anderson, A.S., Gribben, M., and Shepherd, S.D. (2022). An Educational Evaluation of Thiel Cadavers as a Model for Teaching Suturing Skills to Dental Students during the COVID-19 Pandemic. Dent. J., 10.10.3390/dj10070125 ↗
55. Training Courses in Laparoscopic Bariatric Surgery on Cadaver Thiel: Results of a Satisfaction Survey on Students and Professors10.1007/s11695-019-04003-2 ↗
56. Step-by-Step Demonstration of “Sciatic-Nerve-Preserved beyond-LEER” in a Thiel-Embalmed Cadaver: A Novel Salvage Surgery for Recurrent Gynecologic Malignancies10.3802/jgo.2024.35.e112 ↗
57. Validation and Motion Analyses of Laparoscopic Radical Nephrectomy with Thiel-Embalmed Cadavers10.1016/j.cpsurg.2024.101559 ↗
58. Lersch, F., Schnidrig, D., Boemke, S., Djonov, V., Jaggi, D., and Heussen, F.M. (2024). Thiel Cadaver Eye as a Training Model for Sub-Tenon’s Blocks: A Feasibility Study. BMC Ophthalmol., 24.10.1186/s12886-024-03630-3 ↗
59. Integration of Simulated Thoracentesis Using Thiel-Preserved Cadavers in the Teaching of Thoracic Anatomy for Learning Unit III Medical Students: An Innovative Learning Strategy
60. Relationship between Shear Elastic Modulus and Passive Muscle Force in Human Hamstring Muscles Using a Thiel Soft-Embalmed Cadaver10.1007/s10396-023-01317-8 ↗
61. Changes in Deep Neck Muscle Length from the Neutral to Forward Head Posture. A Cadaveric Study Using Thiel Cadavers10.1002/ca.23834 ↗
62. Evaluation of Screw Pull-out from Plate Fixation of En Bloc Distal Radius Resection with Ulnar Reconstruction: Finite Element Analysis and Comparison with Experiments on Thiel Cadavers10.1063/5.0248553 ↗
63. Thiel Cadaver Suitability for Image-Based Abdominal Ultrasound Research10.1016/j.aanat.2025.152713 ↗
64. Cost-Effectiveness Analysis of Thiel Embalming for Surgical Training
65. The Use of Technical Grade Chemicals and On-Site Production of Ammonium Nitrate: A Cost-Effective and Safer Approach to Thiel Embalming10.1007/s00276-025-03672-2 ↗
66. The Tactile Realness of “life” Is Hitting Me in the Face”: Unprompted Student Reflections of Dissection Using Formalin- and Thiel-Embalmed Donors10.1002/ase.70081 ↗
67. Thiel Embalming Fluid—A New Way to Revive Formalin-Fixed Cadaveric Specimens10.1002/ca.22392 ↗
68. Educational Training in Laparoscopic Gynecological Surgery Based on Ethanol-Glycerol-Lysoformin-Preserved Body Donors10.1016/j.aanat.2018.10.002 ↗
69. An odorless, well-preserving injectable solution for cadavers used in classes
70. Innovative Cadaver Preservation Techniques: A Systematic Review
71. Establishment and Evaluation of a Training Course in Advanced Laparoscopic Surgery Based on Human Body Donors Embalmed by Ethanol-Glycerol-Lysoformin Fixation10.1007/s00464-020-07523-6 ↗
72. Characterization of the Mechanical Properties of Human Parietal Bones Preserved in Modified Larssen Solution, Formalin and as Fresh Frozen10.1007/s00276-021-02762-1 ↗
73. Modified Larssen Solution (MLS)-Fixed Cadaver Model for Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Education: A Feasibility Study10.1007/s00464-022-09224-8 ↗
74. Preservation of Cadavers for Surgical Technique Training10.1111/j.1532-950x.2004.04083.x ↗
75. Phenoxyethanol-Based Embalming for Anatomy Teaching: An 18 Years’ Experience with Crosado Embalming at the University of Otago in New Zealand10.1002/ase.1933 ↗
76. Crosado Embalming Related Alterations in the Morpho-Mechanics of Collagen Rich Tissues10.1038/s41598-025-90378-5 ↗
77. Critical Appraisal of Genelyn Soft Embalming for Cadaveric Surgical Skill Training: A Systematic Review10.1002/ca.24236 ↗
78. A Novel Model for Hands-on Laparoscopic Pelvic Surgery Training on Genelyn-Embalmed Body: An Initial Feasibility Study10.1007/s12565-022-00677-4 ↗
79. Simulation of Reconstructive Microsurgery in Soft Embalmed Cadavers: A Teaching Module for Plastic Surgery Residents10.1055/s-0042-1750375 ↗
80. Pinar, S.A., Morrow, J.J., and Kong, C.Y. (2025). A Systematic Review of the Use of Human Body Donor Models for Postgraduate Laparoscopic Surgical Training. Anat. Sci. Int.10.1007/s12565-025-00872-z ↗
81. Learning Gains of Liver Resection and Transplantation Workshop on Genelyn® Embalmed Human Cadavers: Surgical Gastroenterologists’ Perceptions10.1016/j.jceh.2021.01.001 ↗
82. The Usefulness of Genelyn® Embalming Method for Gynaecological Surgical Skill Training: A New Cadaveric Training Model for Laparoscopic Hysterectomy10.1007/s12262-021-02928-6 ↗
83. Advanced Training in Laparoscopic Gastrointestinal Surgical Procedures Using Genelyn®-Embalmed Human Cadavers: A Novel Model10.4103/jmas.JMAS_152_20 ↗
84. Saturated Salt Solution Cadaver-Embalming Method Improves Orthopaedic Surgical Skills Training10.2106/JBJS.17.01256 ↗
85. Surgical Simulation Flexor Tendon Repair Using Thiel Cadavers: A Comparison with Formalin Embalmed Cadavers and Porcine Models10.1177/1753193413520281 ↗
86. Durongphan, A., Suksantilap, S., Panrong, N., Aungsusiripong, A., Wiriya, A., Pisittrakoonporn, S., Pichaisak, W., and Pamornpol, B.L.-I. (2022). Non-Decapitated, Saturated Salt Method-Embalmed Cadaver Technique Development and Application as a Head and Neck Surgery Training Model. PLoS ONE, 17.10.1371/journal.pone.0262415 ↗
87. The Usefulness of Saturated Salt Solution Embalming Method for Oral Surgical Skills Training: A New Cadaveric Training Model for Bone Harvesting10.1002/ase.1925 ↗
88. Advanced Cadaver-Based Educational Seminar for Trauma Surgery Using Saturated Salt Solution-Embalmed Cadavers10.1002/ams2.390 ↗
89. Experience of Raising Flaps Using Cadavers Embalmed by Saturated Salt Solution Method10.1097/GOX.0000000000000523 ↗
90. Training on Skin Flap Elevation in Hand Surgery Using Cadavers Embalmed by the Saturated Salt Solution Method: Effectiveness and Usefulness10.1007/s12565-022-00668-5 ↗
91. Water-Soluble Dye Staining of the Flap Nutrient Artery and Its Perforator Branch in Cadavers Embalmed Using Saturated Salt Solution and Urea Methods: Does Demonstration Using a Dye-Stained Cadaver Increase a Trainee’s Level of Skill Acquisition?10.1007/s12565-025-00823-8 ↗
92. Saturated Salt Solution: A Further Step to a Formaldehyde-Free Embalming Method for Veterinary Gross Anatomy10.1111/joa.12634 ↗
93. Comparative Histologic Assessment of Fetal Cadaveric Tissue Preserved Using the Modified Saturated Salt Solution10.1016/j.morpho.2025.100970 ↗
94. The Current Potential of Plastination10.1007/BF00309677 ↗
95. Cold Temperature/Biodur®/S10/von Hagens’—Silicone Plastination Technique10.1111/ahe.12472 ↗
96. Plastination—A Method for Preservation of Oral Hard and Soft Tissue Biopsy Specimen v/s the Conventional Method of Preservation with Formalin10.4103/jomfp.jomfp_132_23 ↗
97. Hildebrandt, S., Champney, T.H., and Cornwall, J. (2025). The Public Face of Anatomy? History-Informed Ethical Analysis of Human Plastination and Its Relevance for Today. Anat. Sci. Educ., 18.10.1002/ase.70140 ↗
98. A Validated Instrument Measuring Students’ Perceptions on Plastinated and Three-Dimensional Printed Anatomy Tools10.1002/ase.2147 ↗
99. Efficacy of Plastinated Specimens in Anatomy Education: A Systematic Review and Meta-Analysis10.1002/ase.2424 ↗
100. Plastination: An Innovative Method of Preservation of Dead Body for Teaching and Learning Anatomy10.4103/2394-7438.174836 ↗