Dissections techniques

By Tobias Todsen, MD, PhD and Christoffer Holst Hahn, MD

The aim of dissection is to isolate the structures of interest from the surrounding tissue with the least amount of trauma and bleeding. Dissection should be performed along tissue planes, which tends to be more avascular. Traction can facilitate the dissection by exposing the tissue plane and visualize important underlying structures like vessels and nerves. When you find the structure of interest, continue to dissect very close to the structure so you avoid losing the orientation. Keep good hemostasis in the operating field so you can always see the structures you are dissecting and remove unnecessary instruments you do not need at the moment. Remember to rest part of the hand or arm during surgery in order to decrease the required muscle tonus and tremor. Overall, surgical dissection can be divided into blunt and sharp dissection methods. Blunt dissection separates tissue planes by application of shear force in the natural line of cleavage. Sharp dissection is accomplished by incising tissues with a sharp edge from a scalpel or scissor. The dissection method depends on the tissue characteristic and combinations of sharp and blunt dissection are often used during the operation as demonstrated in the video below. Further, different kinds of dissections aids can also be used to ensure hemostasis during dissection (see the chapter about dissection aids).