Careless tissue retraction with a tissue retractor (such as an Austins or Rake
Retractor) can lead excoriation and swelling, mainly around the lips and especially
at the commissure.
This is more likely to occur under general anæsthesia than local anæsthesia.
This commonly occurs when the lips and commissures are trapped between a
(periosteal) elevator (used as a flap retractor) and the neck of the elevator being
used to extract wisdom tooth (third molar), especially if the extraction is difficult
(poor visibility and surgical access). It is all too easy to get carried away with the
extraction and neglect the soft tissues.
Lacerations to the soft tissues can be caused by careless handling of scalpels,
elevators, forceps scissors and sutures.
|Abrasion of the lower lip as a result of contact with the removal of an impacted
lower 3rd molar
Vaseline or moisturising cream should be applied to the lips, pre-operatively and
This happens with surgical drills that are not serviced regularly and properly
maintained. These can be prone to bearing failure resulting in the drills
overheating in normal use, especially if old burrs are used (in an attempt to save
money and excess pressure is applied to the blunt bur because it cuts
inefficiently). The hot drill then comes into contact all with the patients’ soft tissues
resulting in a deep burn.
This is an indefensible disaster and the cosmetic results can be truly appalling.
If a surgical drill is ‘running hot’, it should be immediately discarded and sent for
repair or condemned.
If a surgeon injures a patient with an instrument that is known to be defective, then
they will only have themselves to blame when they are sued for negligence.
Poor vigilance while using an electrical cautery
(diathermy) or laser is another indefensible cause of damage to surrounding soft
When these instruments are in use, non-conducting and non-reflective retractors
should be used and in the case of lasers all surrounding areas should be protected
by wet swabs. Extreme care should be used when using monopolar cautery to
coagulate a blood vessel via a non-insulated pair of tissue forceps in case they
should come into contact with the surrounding soft tissues.
|Last Updated 23rd May 2011