Cold Dissection in Hostile Surgical Fields Using a Non-energized Electrocautery Blade Tip: A Novel Technique

Abstract Background: Hostile surgical fields are irradiated, infected, or previously operated regions, characterized by fibrosis, loss of normal anatomical planes, and reduced tissue resilience. In such settings, critical structures may lie immediately beneath adherent or necrotic tissue, making dissection hazardous. Conventional instruments, such as scissors, mosquito forceps, and surgical blades, are sharp and carry a risk of perforation; diathermy risks thermal necrosis in compromised tissue.;Methods: To address these risks, we propose repurposing a non-energized electrocautery blade tip as a tactile navigator for safe cold dissection. Using the Sweep-Probe-Scrape (S-P-S) technique, the blade tip serves as a blunt probe for interfacial dissection and development of tissue planes adjacent to tethered vessels through tangential sweeping and longitudinal scooping.;Results: The blade tip’s flat geometry distributes contact pressure broadly rather than concentrating force at a single point. Its rigid, non-hinged shaft transmits direct tactile feedback to the operating hand. When detached from the pencil handle and held between the fingers, the blade eliminates the risk of inadvertent current activation while enhancing tactile sensitivity. This technique is demonstrated in a post-laryngectomy wound within an irradiated neck, where dissection was performed adjacent to the internal jugular vein.;Conclusion: This technique repurposes a readily available instrument for controlled cold dissection in hostile surgical fields, where conventional tools may increase the risk of injury to critical underlying structures. The S-P-S technique provides a simple, reproducible option for selected high-risk scenarios in which precise tactile dissection may reduce the risk of catastrophic injury.;Keywords: Hostile surgical field; cold dissection; electrocautery blade tip; wound debridement; neurovascular preservation; tactile dissection