In areas poorly visualized because of unfavorable operating conditions, cleavage dissection can be easily and safely carried out with a small pusher soaked in a solution of hyaluronidase. Such practice replaces or simplifies sharp dissection, thus minimizing the risk of damage to arteries, nerves, or other vital structures and permitting surgical maneuvers in some areas which have been previously inaccessible. Areolar tissue separates effortlessly from the surrounding structures and is readily dissected free.
Streuter1 employed hyaluronidase solutions in 27 operations and concluded that its topical application considerably facilitated separation of closely adherent vital structures, while it had little effect on intact pleural or peritoneal surfaces and had no apparent deleterious effects on any tissues. Britton and Habif,2 in a review of the clinical uses of hyaluronidase to 1953, explained the mechanism of its lytic action. The enzyme, which is obtained from bovine testicular extract, depolymerizes hyaluronic acid, thus