(1) Stripping Method for Skin Dissection:
The stripping method mainly involves peeling tissues beneath the skin. There are two primary peeling techniques: sharp peeling and blunt peeling.
1.Sharp Peeling for Skin Dissection:
Sharp dissection is a method of separating tissues using a surgical knife or scissors under direct vision. When using a surgical knife, the blade should be perpendicular to the peeling surface and pushed to separate the tissues. When separating relatively loose tissues, scissors are generally used. The tissue is first cut and closed, then inserted into the tissue gap, and finally opened to separate the tissues.
After ensuring there are no important blood vessels or nerves, the tissue is gradually pushed forward. Sharp dissection, performed under direct vision, offers advantages such as clear hierarchy, minimal bleeding, easy separation or cutting of tissues, mild tissue damage, and reduced scar formation after healing. It is commonly used to separate scar tissue from denser tissues such as tendons, ligaments, and the tunica vaginalis.
2.Blunt Peeling for Skin Dissection:
Blunt dissection is a method of separating tissues under non-direct vision using fingers, knife handles, stripping ions, and other specialized tools. During blunt separation, the main approach is to use tactile sensation to probe, separate, turn, and move forward to the desired position. In challenging separation areas, it is crucial to avoid forceful separation to prevent accidents. Blunt dissection can cause significant damage to tissues such as subcutaneous, muscle, and fascia, and is generally only used to separate normal anatomical gaps, loose connective tissues, and benign tumors and cysts with intact capsules. Blunt dissection is commonly employed in cosmetic surgery for larger and deeper dissections, such as breast augmentation, wrinkle removal, and the creation of large skin flaps.
(2) Operational Skills for Skin Dissection:
1.Familiarize Oneself with Local Anatomy and Correctly Identify Tissues (Operational Skills for Skin Dissection):
During the peeling process, it is essential to have a good understanding of the normal tissue structure and its adjacent relationships. It is also important to be familiar with the natural gaps present in the tissue. Operating along these natural gaps can result in less bleeding, faster dissection, and prevent damage to surrounding normal tissues. Additionally, a clear surgical field post-dissection makes it easier to identify tissue structures, facilitating a thorough and safe operation. It is crucial to note that dissection around vital organs must be conducted under direct observation to ensure safety and reliability.
2.Combine Sharp and Blunt Peeling, with Sharp Peeling as the Primary Method (Operational Skills for Skin Dissection):
Cosmetic surgery typically involves shallow areas with relatively small surface areas. Therefore, sharp dissection is often the preferred method as it can be performed under direct vision. However, in practical operations, a combination of sharp and blunt peeling is frequently employed. For instance, in breast augmentation surgery using an anterior axillary fold incision, sharp dissection can be utilized under direct vision to the outer edge of the pectoralis major muscle. Subsequently, blunt dissection can be carried out in the posterior space of the pectoralis major muscle to create a cavity for the implant.
3.Select the Appropriate Scope of Dissection (Operational Skills for Skin Dissection):
The scope of dissection should be determined based on the specific surgical procedure. Typically, the size of the dissection area should be decided according to the size of the excised lesion tissue, skin tension post-suturing, required flap area, and its blood supply. If there is excessive skin tension at the incision site and the wound edges appear white after suturing, it indicates insufficient dissection.
In such cases, it is necessary to expand the dissection area rather than forcibly closing the wound, as this may lead to poor healing and visible suture scars. Particularly when dissecting areas like the corners of the eyes, mouth, and nostrils, special attention should be paid to maintaining the normal shape and position of the facial features post-suturing.
4.Determine the Correct Depth of Dissection (Operational Skills for Skin Dissection):
The appropriate depth of dissection varies depending on the surgical procedure and the anatomical structures at the dissection site. For instance, during a rhytidectomy, peeling should be performed in the space beneath the cap aponeurosis, where the risk of scalp necrosis is minimal due to the presence of crucial blood vessels and nerves in this layer. Similarly, when dissecting the temporal region, care must be taken to operate safely in the lower layer of the superficial temporal fascia to avoid damaging important structures like the superficial temporal artery, vein, and frontal branch of the facial nerve.
When stripping the fascia layer in front of the platysma muscle, it is important not to go too deep to prevent damage to blood vessels and nerves beneath the muscle. In clinical practice, the depth of dissection is usually determined based on the location of the implant to be inserted. For example, breast augmentation may involve dissection in the posterior mammary gland, suprafascial space, or posterior pectoralis major space, while dissection in the trunk and limbs is typically performed in the upper layer of the deep fascia.
5.Grasp the General Rules of Stripping:
The principles of stripping generally involve progressing from simple to complex, easy to difficult, near to far, shallow to deep, surrounding to central, and step by step.