(About Scissors)
Instrument usage: Scalpels are used to cut, incise, separate, or excise tissue.1 Scalpels are used in almost all surgical procedures. It is most common to use a scalpel to cut through the skin, but can also be used at other times during the surgical procedure. All surgical specialties use scalpels.
Key differences:
Most scalpels have reusable handles made of brass and disposable blades made of carbon steel.1,2 The handles have various widths, lengths, and angles.1 A longer handle would be used deeper in a body cavity, while a shorter handle would be used superficially. The scalpel blades have various sizes and shapes.1 The scalpel blade may have one or two cutting edges and is designed for very specific purposes.1
There are specific blades for different types of surgery, such as a 10 blade or a 20 blade, which is larger, for a skin incision, while a 15 blade is commonly used for more delicate cutting or plastic surgery.
There are many different sizes and shapes of beaver blades for arthroscopy surgery and other surgical specialties. Beaver blades may be inserted into a universal handle that is nondisposable or may come on a disposable handle.
Specialty blades, such as a lancet knife, are most often completely disposable or have a disposable blade tip.
Safety on the sterile field:
The scalpel blades can be changed during the procedure when necessary.2 When changing the scalpel blade during the procedure, a heavy clamp, such as a Kelly clamp, should be used to detach and attach a new blade.1 Fingers should never be used and needle holders are not recommended or designed to load a scalpel blade.1
It is important that when a scalpel blade is used on the skin, it is not also used deeper in the body cavity. Because skin cannot be considered sterile, this blade is considered dirty. The blade should be taken out of use after the skin incision.
It is important to keep scalpels separate from other instruments and protect the sharp edges when cleaning, sterilizing, and storing them.1 It is also important to keep blades safely separated on the sterile field and all knife blades, used and unused, with other sharps.
The scrub personnel must use proper precautions during the handling or disposing of scalpels to prevent injury and/or damage to the instrument.1
When passing a scalpel, a neutral zone or hands-free technique should be used so that the scrub personnel uses a no-touch technique.3 Sometimes the surgeon will use a hand signal with the first and middle fingers, as illustrated here, to indicate the need for scissors.
Instrument names:
The scalpel that is initially used for the skin incision is called the “skin knife” or “dirty knife.” It may also be called by the name of the blade, such as a “10-blade” or “20-blade.” When a longer knife handle is needed in a body cavity, it may be called a “long knife.” Usually, a longer handle would use a finer blade, such as a 15 blade. Specialty scalpels are most often called by the type of blade it is associated with.
References:
1. Phillips, Nancymarie. Berry & Kohn's Operating Room Technique. Elsevier Health Sciences, 2016.
2. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
3. Guidelines for Perioperative Practice. Sharps Safety. AORN, Inc, Denver, CO; 2021.