An autopsy is a medical examination performed after death to determine the cause, manner, and mechanism of death, or to evaluate any diseases or injuries present. The process of closing the head is a specialized procedure focused on returning the body to a state suitable for viewing or burial. This restoration aims for structural stability and a discreet cosmetic appearance, respecting the deceased and their family. The closure involves meticulously reassembling the skull and securing the scalp.
Replacing the Skull Cap
Examining the brain requires removing the calvarium, which is the dome-shaped upper part of the skull. A specialized oscillating saw makes a circumferential cut around the skull, allowing the skull cap to be lifted away. This cut is typically made around the temples and the back of the head, well below the hairline.
Once the brain examination is complete, the skull cap is carefully positioned back into its original place. Since the cut creates a precise bony seam, the main goal is to prevent the cap from shifting or sinking when the scalp is pulled back over it.
Pathologists or autopsy technicians secure the calvarium to the skull base using small metal pins, specialized plastic fasteners, or wires threaded through drilled holes. This fixation ensures the bone fragments are stable and prevents movement that could interfere with the final cosmetic appearance. Sometimes, the cranial cavity is filled with absorbent material to help maintain the natural contour of the head once the skull cap is replaced.
Securing the Scalp Incision
The incision made in the scalp to access the skull is strategically placed for maximum concealment. The most common approach is a coronal incision, running from behind one ear, across the top of the head, and down to the other ear. This path ensures the resulting suture line is hidden by the hair.
To close this long incision, the prosector uses specific suturing techniques designed for strength, speed, and discretion. The running baseball stitch is frequently employed due to its efficiency and ability to create a strong, tight closure that prevents fluid leakage. This suture passes through the tissue beneath the skin in a continuous, looping pattern.
Alternatively, some facilities use a running subcuticular suture, placed just beneath the skin’s surface. This technique offers a more cosmetic finish by minimizing the visibility of the thread, though it may take slightly longer to perform. The primary focus is to tightly reapproximate the scalp edges over the secured skull cap, creating a neat and secure seam.
Final Appearance and Restorative Measures
The autopsy closure procedures are designed with the final appearance of the deceased in mind. Since the cranial incision is deliberately placed high and often behind the ears, the suture line is typically concealed by the hair. This strategic positioning makes the evidence of the procedure virtually invisible during an open-casket viewing.
For individuals with little to no hair, funeral directors use restorative measures when the closure is not perfectly aligned. They apply specialized waxes or compounds to smooth and conceal the incision line before cosmetic application. The firm reassembly of the skull cap and the tight suturing of the scalp ensure the natural shape of the head is preserved for effective cosmetic restoration and hair styling.