Overview

  • surgeon's main cutting tool.
  • least traumatic way to divide tissues 
  • best for incising
    • dense tissues
    • tissues that can hold under tension while making the incision

Goal

  • to use a single pass to completely incise the tissue to the desired depth

Skills to Practice

  1. fingertip grip
  2. palm grip
  3. pencil grip
  4. creating an incision edges with consistently perpendicular to the tissue’s surface
  5. controlled depth of incision for the entire incision's length
  6. making the desired length of incision in a single pass
  7. making a controlled entry into a cavity using the pencil grip

Holds

Fingertip Grip

  • most common grip
  • used to make a long, smooth incision 
  • provides the best accuracy and blade stability when making long incisions
  • maximizes contact of blade's cutting surface with the tissue

The Hold

  • handle held in the dominant hand
  • cutting pressure applied by fingers (primarily index finger)
  • entire arm, not just the hand, moves to make the incision

Palm Grip

  • strongest grip
  • used when need strong pressure to incise the tissue
  • uses entire arm

The Hold

  • hold handle in palm of dominant hand
    • place thumb on one side of handle
    • rest index finger on top of handle or blade (optional)
    • wrap remaining fingers around the handle
  • cutting pressure applied by palm and fingers
  • entire arm moves to make the incision

Pencil Grip

  • this grip limits amount of the blade’s cutting surface contacting the tissue. 
  • useful for short, precise incisions
  • jagged cut occurs when used to make longer incisions

The Hold

  • handle is held in dominant hand like a pencil
    • handle is held between the thumb and index finger
    • handle rests on remaining fingers
    • fingers are moved to make the incision rather than arm
    • blade can be reversed for improved visualization and control as shown below on the right
Standard pencil grip Reverse pencil grip

Reverse pencil grip

How to Use

Slide Cutting

  • typically uses fingertip grip and belly of blade
    • increases tissue’s contact with blade’s cutting surface
    • cushions against sudden changes in pressure and directions
  • used for long tissue incisions
  • pressure exerted by index finger on the blade is adjusted according to the tissue’s innate toughness and desired depth of incision desired
  • skin is stretched laterally on either side of the proposed incision by the non-dominant hand
    • stabilizes tissues so easier to cut
    • opens edges to monitor incision depth
    • this hand is advanced as incision progresses
  • blade remains in contact with surface and advances until incision is complete
  • right handed surgeons: generally make incisions left to right or towards their bodies
  • left handed surgeons: generally make incisions from right to left or towards their bodies

Slide cutting video 1

Press Cutting

  • typically uses the pencil grip and tip of the scalpel blade
  • makes a stab incision
  • used to enter abdominal cavity or hollow organ

Standard technique

  • tip placed on surface of cavity or hollow organ
  • pressure applied to tip until it enters the cavity
  • tendency to enter cavity suddenly (poor control)
  • index finger may be placed along side of blade as a “stop” to control depth of penetration

 

Reverse technique

  • blade is reversed so cutting surface is faces surgeon
  • this allows:
    • improved control over depth and rate of penetration
    • improved visualization
    • improved protection of vital underlying tissues
  • recommended in most situations

Skills to Master

The Goal

The goal when using a scalpel blade is to use a single pass to completely incise the tissue to the DESIRED depth and length.

Practice: Scalpels

  1. controlled depth of incision
  2. making the desired length of the incision in a single pass
  3. creating incision edges perpendicular to the tissue's surface
  4. making a controlled entry into a cavity (e.g. abdominal cavity or a hollow organ)

Controlled depth of incision

  • a tentative cut requires multiple attempts to reach the desired depth and creates jagged edges (this is inefficient and traumatic)

illustration showing jagged skin

jagged edges created by tentative cut

  • too strong an incision may damage deeper structures

Practice: Incise different fruit (eg. banana/orange/mango)

  1. use fingertip grip and slide cutting technique
  2. single complete incision from top to bottom
  3. incision perpendicular to the “skin”
  4. no stopping
  5. cut through only the skin of the fruit
  6. practice until you can consistently and efficiently use a single pass to completely incise various "tissues" to the desired depth

Desired Length

Making the desired length of incision in a single pass

  • decide in advance the location and length of incision required

    (Remember that an incision heals from side to side not end to end)

  • the slide cutting technique with a fingertip grip is most commonly used.

Incision Fingertip Grip

Controlled Entry

Making a controlled entry into the abdominal cavity or a hollow organ

  • Ensure vital structures in the area are protected and avoided
  • scapel is held using either the standard or reverse pencil grip
  • tip of the blade is placed on the tissue or organ
  • middle finger can be placed along side of blade to serve as a stop
  • steady pressure is applied to the tip until it penetrates the tissue or organ
  • the blade is then withdrawn
  • practice withg different tissues until consistently controlled entries are achieved