Polyester Sheet Plastination: Technical Foundations, Methodological Advances, Anatomical Applications, and AQUA-Based Quality Analysis

Abstract

Background/Objectives: Plastination with polyester resin is a consolidated technique for anatomical preservation, particularly valuable in neuroanatomy education and radiological correlation. This review synthesizes the principles, technical evolution, methodological variations, applications, and limitations of polyester-based sheet plastination methods (P35, P40, P45). Methods: Key documents were analyzed to trace the transition from P35, recognized for excellent gray-white matter contrast but technical complexity, to P40, offering greater transparency, lower viscosity, improved strength, and simplified UV-curing. P45 was also reviewed, especially for large body sections using water-bath curing. Innovations included vertical curing chambers, active-passive vacuum cycles, resin reformulations, and strategies to reduce tissue shrinkage. Methodological quality was assessed with the AQUA tool, which evaluates five domains: Objectives, Study Design, Methodology, Descriptive Anatomy, and Results Reporting. Results: Plastination proved applicable in medical and veterinary education, as well as morphometric and imaging-based research, improving anatomical understanding and CT/MRI correlation. AQUA analysis revealed low risk of bias in Objectives and Descriptive Anatomy, but frequent unclear or high-risk assessments in Study Design, Methodology, and Results Reporting, mainly due to limited details on sample selection, resin handling, curing, and reproducibility. Publications after 2010 showed improved methodological rigor, reflecting growing standardization and better reporting. Conclusions: Polyester sheet plastination remains a versatile, high-impact tool, though it requires specialized infrastructure, trained personnel, and strict environmental control. Future development should focus on protocol standardization, international dissemination, integration with digital technologies (3D models, virtual reality), and sustainable alternatives. Progress depends on inter-institutional collaboration, technical training, and open access to updated resources.