Overview

  • a common surgical tool for cutting or dissecting tissues.
  • used to cut loose tissues, the blades stabilize the tissues during cutting
  • provides very good control of depth and direction of cutting. 
  • more traumatic than scalpel because they crush during cutting.

Goal

  • contolled use of tissue scissors during scissor cutting, push cutting and blunt dissection

Skills to Practice

  1. wide-based tripod grip
  2. accurate scissor cutting
  3. controlled push cutting
  4. accurate, efficient blunt dissection 

Basics

  • scissors are classified according to
    1. tips (sharp-sharp, blunt-blunt, sharp-blunt)
    2. blade shape (straight or curved)
    3. cutting edge (normal or serrated)
  • blunt-blunt tips with a normal cutting edge are typically used
  • straight scissors provide more mechanical advantage for cutting thick or tough tissue
  • curved scissors allow greater maneuverability and visibility

  • scissors come in a variety of sizes and designs depending on their intended use
  • commonly used basic types include: General Prupose Mayo Metzenbaum

Scissors

 

Mayo scissors

Mayo Scissors

  • sturdy design
  • used to cut heavier tissues (eg. linea alba, thick fascia)
  • [ memory tip: “short” name” → “short” handle]

Metzenbaum scissors

Metzenbaum Scissors

    • relatively finer design
    • used for fine tissues and blunt dissection (eg. subcutaneous and light fascia)
    • [ memory tip: “long” name”  → “long” handle]

General purpose ("suture") scissors

General Purpose Scissors

  • relatively shorter and broader blades
  • commonly lower quality (cheaper) so can be frequently replaced as become dull or damaged
  • used to cut sutures and other materials, NOT tissues
  • preserves the sharpness of the tissue scissors

Holds

Wide based tripod grip

  • most efficient hold
  • thumb and ring finger through the rings
  • middle finger is placed on top of the finger ring
  • index finger is placed along handles towards fulcrum (improves control of tips)
  • avoid putting fingers too far into rings as limits maneuverability and comfort (stay above first knuckle)
  • avoid putting index or middle finger though ring as decreases stability and efficiency
  • left-handed surgeons: most adapt to using scissors with right hand but left handed scissors are available

Backhand grip

Thumb-middle backhand grip

  • typically used for cutting from left to right (less awkward)
  • thumb and middle finger through the rings with handle resting on third and fourth fingers

    Thumb-index backhand grip
  • can be modified when cutting fowards body
  • thumb and index finger through the rings
  • more comfortable efficient and controlled

How to Use

Scissor cutting

  • more traumatic than scalpel but gives excellent control

Technique:

  • blades partially closed over tissue and elevated slightly (stabilizes tissues)
  • tips closed to cut the tissue
  • only use the tips
    • more crushing trauma and jagged edges if entire blade used

When continuing an incision

  • tips are not closed completely
  • blades are re-opened, tips advanced and more tissue cut
  • continues for entire incision length
  • avoids creating a series of jagged cut

Push cutting

  • efficient cutting method
  • used for longer incisions in light fascia

Technique:

  • begins with a scissor blades partially closed (tip still open)
  • continue by pushing the nearly closed blade forward through the tissue
  • tissue is cut in one continuous motion without further opening/closing of the blades
  • scissors should advance easily without tearing the tissue or technique is abandoned

Blunt dissection

  • used to separate fine tissue attachments between anatomic tissue planes and isolate delicate structures

    • nice for separating muscles, fat and fine fascial planes
    • more traumatic than sharp dissection (scalpel or scissor)
    • creates more dead space
    • not for dividing strong fascial attachments

Technique

  • closed tips of the scissors are inserted into tissue
  • blades are opened separating (tearing) loose tissue connections
  • scissors tips are removed without closing the blades to prevent uncontrolled cutting
  • the process is repeated as needed

Blunt dissection