Scalpels
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Surgical instruments have a long history, but their modern versions have only been around for a relatively short period of time. The macairion, a surgical knife introduced by Hippocrates, served as the precursor to the modern scalpel, which nevertheless carries a notable similarity to its ancient predecessor.1
Available in different shapes and sizes for diverse surgeries, contemporary scalpel blades and handles are typically crafted from hardened and tempered steel, stainless steel, and high carbon steel, with blade shapes designed according to their intended use. Recognized as indispensable surgical tools, scalpel blades contribute to precise incisions and minimal scarring, which is particularly crucial in minimally invasive, ophthalmic, cardiovascular, and endoscopic surgeries. Cutting in a firm and controlled way, usually at angles of 30–90 degrees from the tissues, necessitates holding the instrument in various ways, often placing a steadying forefinger along the back of the instrument. The tissue through which the scalpel is incising should also be steadied and put under a slight degree of tension.2
The demonstration of surgical scalpels in this video provides valuable insights into their usage. The handles are available in different designs, serving two functions: fitting the appropriate size of surgical blades and ensuring a firm hold to reduce the chance of slipping.
Surgical blades come in sterile packaging, and the number on a surgical blade communicates both its size and shape. This video demonstration aids in understanding how each blade is tailored to meet certain demands in surgery. Some common types include:
- No. 10 blade: used for making large incisions in muscle and skin.
- No. 11 blade: carries an elongated triangular shape with a sharp edge and a pointed tip, making it well-suited for stab incisions.
- No. 12 blade: features a crescent-shaped blade sharpened along the inside edge of the curve. It is sometimes utilized as a suture cutter but also for arteriotomies or pelviolithotomies.
- No. 15 blade: features a small, curved cutting edge and is commonly employed for making concise and accurate cuts.
This video further explores the proper technique for mounting a scalpel blade onto a handle and safely removing it, highlighting the importance of selecting an appropriate handle based on size, weight, and length to ensure optimal precision during surgical procedures. The necessity of careful handling of scalpels to prevent accidental injuries is emphasized.
In summary, the persistent evolution of surgical scalpels from ancient prototypes to modern design underscores their critical role in achieving successful surgical outcomes. The careful choice of blades and handles, based on both historical practices and modern requirements, enhances the accuracy and safety of contemporary surgery.
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Citations
- Ochsner J. The surgical knife. Bull Am Coll Surg. 1999;84(2).
- Crumplin MKH. Surgical knives: the scalpel. Brit J Surg. 2023;110(1). doi:10.1093/bjs/znac344.
Cite this article
Buckner B. Scalpels. J Med Insight. 2023;2023(300.1). doi:10.24296/jomi/300.1.
Procedure Outline
Transcription
Surgical scalpels come in a variety of shapes and sizes,and often the term scalpel and surgical knifeare used interchangeably, but there is a difference.The difference between a knife and a scalpelis that a scalpel has a reusable handlebut a disposable blade.And a knife is both a reusable handle and blade combination.
Each blade has a specific purpose.A number 10 blade is for large incisions,a 15 is for small incisions, a 12 is a sickle knifemade for removing kidney stones or tonsils.And then the 11 blade is a puncture or spear point knifethat can be used to drain abscessesor to gain access to a duct or blood vessel.
The 10, the 15, and the 12 and 11 will all fiton a number 3 knife handle, a number 7 knife handle,and a number 9.If the blade is a size 20 or higherthen those blades go on a number 4 knife handle.The blades are much bigger,and the opening in the blade is much bigger,so the handle has to be bigger.
To load a blade onto a knife handle,the first step is to make sure we have the orientationof the knife handle correct.I can read the number on the knife handleand I have the grips facing up.This cutout where the blade is going to fithas got to be face-up.To do it the other direction, the bladewon't be able to fit on.
So with the knife handle in the proper alignment,I'm going to take my needle driver, or needle holder,and apply it on the dull side of the bladeabove the opening.Now, the tip of my knife handle is going to come inthrough the bottom, and I'm going to introduce itwhere the opening goes from wide to narrow,and I'm going to slide it back.Once the blade is on, I could check it,I could even turn it over and tap itto make sure that it's incapable of falling off.
To remove this blade, I'll go below the opening,grab the blade and only the blade, very gently lift up,and push off with my thumb, and the blade comes right off.
It does not matter what size blade we're applying,the procedure is still the same.On the dull side, grab the blade above the opening,introduce the tip from the bottom,put the tip where we go from wide to narrow,and slide it right on,you feel and hear the click,we can turn it over and tap it,make sure that it is good and secure.Once again, to remove the bladewe'll apply the needle holder underneath the opening,lift up slightly, and push off with our thumb,and it comes right off.If we feel like we're in a bind or we're pushing too hard,stop what you're doing and readjust.
All of these blades, except for the 20 and higherwill fit on a number 3 or a number 7.The most common use of a number 7 knife handleis with a number 11 blade to do a punctureor an arteriotomy.Once again, we put the needle holderabove the hole on the dull side and we will introducethe tip of the knife handle right into the openingwhere we go from wide to narrow and we lock right on.We feel the click. We can tap it to make sureit's not going anywhere, even pull on the blade.And once again to remove it,we will apply the needle holder below the opening,lift up barely, and then push off with our thumb,and off comes the blade.
The number 12 is done the same way.From underneath the blade we introduced the tipfrom where it goes from wide to narrow,and it slides right on.It's good and secure.To remove it, we will grab the bladeand only the blade, underneath the opening,barely lift up, and push off with our thumb,and it comes right off.If we're having trouble doing that,stop what you're doing and readjust.
Larger blades, size 20 and up, are for large incisions,autopsies, things like thoracoabdominal incisions.You'll notice that the openingin the blade is much larger.Although the number 4 knife handleand the number 3 look similar, they are not.Only blades 20 and higher will goon a number 4 knife handle.But the same process applies.On the dull side, place the needle holder above the hole.From underneath the blade, introduce the tipright where we go from wide to narrow,and slide right on, and it locks in place.It's good and secure.We could turn it over and tap it,make sure it doesn't fall off, and we're ready to pass it.To remove the blade, just like in the other sizes,we put the needle holder on the blade and blade alone,barely lift up, and then push off with our thumb,and off it comes.It ought to go very smoothly.If it doesn't, stop what you're doing and readjust.