INCISION 



29 



pussible in order to facilitate the cutting process. v A loose 

 tissue is difficult to cut even with a keen edge, whilst a tense 

 one is cut with facility even when the edge is quite dull. 

 This desired tension is usually obtained in simple cutaneous 

 incisions by stretching the skin between the thumb and index 

 finger (Fig. 14). Areolar tissue is tensed by picking it up 

 with the tissue forcep ; the parts to be incised in ablating a 

 tumor are tensed by grappling the tumor and surrounding 

 tissues with strong toothed forceps or tenacula ; the tendon is 



Fig. 14 — Incision by Tensing Skin with Thumb and Index Finger. 



tensed by extending the articulations over which it passes ; 

 etc., etc. This feature of surgical technics is of exceptional 

 importance, both in regards to speed and exactness. Each 

 stroke of the knife is more deliberate and accomplishes more 

 than if the tissues lie lax. It also temporarily arrests bleed- 

 ing at the seat of dissection, by bringing tension on the 

 divided blood vessels. 



Fig. IS— Skin Tensed by Left Hand. 



When the skin is once opened by incision, further prog- 

 ress is impossible without the aid of an assistant, who divides 

 his time between bailing out the blood and assisting in main- 

 taining the desired tension here and there as directed, and in 

 accordance with the particular work at hand. The bailing 

 of blood must be continuous ; every particle must be soaked 

 up with the sponge or cotton pledget as fast as it masks the 

 anatomical structures to be subsequently incised. Other- 



