TISSUE HANDING
The difference between an acceptable and an excellent .surgical outcome often rests on how the surgeon handles the tissues. The use of proper ‘incision and flap design techniques plays a role; ‘however, tissue also must be handled
carefully, Excessive pulling or crushing, extremes of temperature, desiccation, or the use of unphysiologic chemicals easily damage tissue. Therefore the surgeon should use care whenever touching tissue. When tissue forceps are used, they should not be pinched together too tightly; rather, the}’ should be used to delicately hold the tissue. When possible, toothed forceps or tissue hooks should be used to hold tissue (Fig. 3-4). In addition, tissue should not be overaggressively retracted to gain greater surgical access, This

dimension (y), and preferably flap should have x = 2)’. 8, When releasing, incision is used to reflect a
two-sided flap; incision should be designed to maximize flap blood supply by leaving wide base.
Design on left is correct; design on right is incorrect. C, When “buttonhole” occurs near free edge of
flap, blood supply to flap tissue on side of hole away from flap base is compromised.
includes’ not pulling excessivelyon the cheeks or tongue during surgery.When bone is cut, copious amounts of irrigation should be used to decreasethe amount of bone damage from heat.’ Soft tissues should also be protected from . frictional heat or, direct trauma from drilling equipment.Tissues should not be allowed to desiccate; open wounds should be frequently moistened or covered with a damp sponge. Finally, only physiologic substances should come in contact with. living .tissue. For example, tissue forceps used to place a specimen into formalin during a biopsy procedure should not be returned to the wound until any contaminating formalin is thoroughly removed. The surgeon who handles tissue gently is rewarded with grateful patients whose wounds heal with fewer complications.