Exposure and Soft-Tissue Dissection

The underlying premise of this article is that a thorough knowledge of anatomy, both topographic and deep, is the fundamental basis for all soft-tissue dissection. The surgeon must begin the dissection in normal anatomy, where structures are easily recognizable, and work toward the area of pathology where the anatomy may be radically distorted. Planes of anatomy are the key to soft-tissue dissection, and once a normal anatomic plane is identified, the surgeon should stay in that plane. All soft tissues are damaged by our most precise attempts at careful dissection, and in handling soft tissues, contact with sharp or toothed instruments must be minimized and purposeful. Postoperative scarring is the enemy, but the deleterious effects of tissue adherence can be minimized by starting active and passive motion within 3 to 5 days postoperatively, unless the operation itself dictates longer immobilization.