DISSECTION 31 



tissues, organs or structures are deep-seated it is often neces- 

 sary to dissect through the superficial tissues to reach them, 

 but the principal indications for dissection are healthy or 

 normal structures to be removed from the body. Thus, a 

 tumor is first dissected from its attachments and then re- 

 moved (ablated) ; or a part of a nerve is first dissected from 

 its areolar connections, and then resected. 



Dissection is an important- surgical process, constituting 

 the major part of many complicated operations. _It is gen- 

 erally the most intricate and delicate portion of the tech- 

 nique. When a structure is once well isolated by dissection 

 its subsequent management is a trifling matter. A, nerve 

 tumor, necrotic tissue, or organ, well isolated by a painstak- 

 ing dissection in which the flow of blood is well controlled, 

 is easily removed with neatness and dispatch, whilst one that 

 .is poorly dissected and is masked with blood, is always an- 

 noying.' Partially hidden amongst its relations the desidera- 

 tum may be difficult or impossible to execute, and thus leave 

 a cause for an unsuccessful termination. 



In fine, dissection is a conspicuous, salient, prominent, 



Fig. 16 — Grappling or Tumor Forceps. 



indispensable surgical process in almost every operation. 

 Often it is carelessly or hurriedly done, in the haste to reach 

 the desired end, with unfortunate results. To dissect well 

 is to operate well. 



INSTRUMENTS. — As dissection is so often but a suc- 

 cession of incisions, the same instruments suffice. The 

 scalpel, bistouries, and scissors, to which may be added the 

 tissue or dissecting forceps, grappling forceps, tenacula and 

 retractors, are the instruments required to execute the vari- 

 ous dissections. Sometimes the hands, the finger tips, knife 

 handles, or other blunt objects can be conveniently and ad- 

 vantageously used. 



TECHNIQUE.— The scalpel in the right hand, held as a 

 pen-holder, the tissue forceps in the left hand, picking up the 

 tissues to be cut, and the assistant energetically bailing out 

 the blood, is the proper manner in which ordinary dissections 

 are executed. If a vessel spurts it is ligated or twisted. If 

 a structure is large, as a tumor, the grappling forceps or 



