03. Handling of Instruments - Scalpel
If you are new to suturing, you will need to learn to recognize each of the instruments you are going to use, understand their function and practise the basic techniques of using them.
This section covers the scalpel.
In this module
03.01 Scapel
A scalpel is a razor-edged blade on a handle. There are two types of surgical scalpel: reusable and disposable.
Reusable scalpels consist of a blade that is replaced after every use, attached to a stainless steel handle that can be sterilised and re-used multiple times. In a hospital setting, this type is more likely to be used in order to reduce waste and to allow doctors to work with a variety of blades and handle sizes.
Disposable surgical scalpels are usually single-piece with a plastic handle. This is the type provided in our Hands-on Kit for practice. Although you will use the same scalpel multiple times for practice, in a clinical setting you would dispose of the entire scalpel after a single use.
03.01.01 Principles Video 1
A scalpel is essential for incising the skin and for sharp dissection. Held flat, it can also be useful for carefully undermining the skin edge to relieve tension.
A razor edged blade engages over a flange on the scalpel handle.
Several sizes of scalpel handle are available and size 3 is appropriate for most purposes. Each handle can be fitted with disposable blades of different shapes.
03.01.02 Principles Video 2
The scalpel can be held in one of two ways:
For making large incisions e.g. laparotomy, and subcutaneous fat dissection, hold the scalpel like a table knife, with your index finger guiding the blade. This method permits good downward pressure and is safer in terms of inadvertent injury.
For finer control and for small and delicate incisions, e.g. excision biopsy, hold the scalpel like a pen.
03.01.03 Principles Video 3
You will use your non-dominant hand when incising, to steady the skin. Make sure to cut away from your own fingers or thumb, to avoid the risk of injuring yourself. Never pass a scalpel blade first, but rather handle first with the blade pointing down. The safest way is to put it in a kidney dish before passing it.
Always dispose of used blades and single-use disposable scalpels in a sharps container.
03.01.04 Scalpel Handles
Scalpel handles can be sterilised and re-used, whereas scalpel blades need to be replaced after each use.
The most commonly used handles are numbers 3, 4 and 7.
Number 3 is appropriate for most purposes including skin incision and cutting superficial tissues such as the subcutaneous layer. It is a flat, short handle and is used with blades number 10, 11 and 15.
Number 4 is a bigger version of number 3, for use with larger blades in the number range 19 to 36.
Number 7 is a long pen-like handle, rounded at the front and flat at the back. It is used for precise cutting with blades number 10, 11 and 15.
03.01.05 Scalpel Blades Video 1
A selection of disposable sterile blades of different shapes is available. Each blade has a straight blunt edge and a razor-sharp cutting edge and point. The blade has a central hole which slides over a corresponding tongue on the scalpel handle.
The most useful general-purpose blade is the number 15. It is used for short and precise incisions in a variety of surgical procedures. The blade has a small, curved cutting edge with a flat back. Use it with handle number 3 or 7.
03.01.06 Scalpel Blades Video 2
The no. 11 blade is used for precision cutting and sharp, stab incisions. The blade is elongated and triangular with a strong pointed tip, flat cutting edge parallel to the handle, and a flat back. It is used with handles number 3 or 7.
The no. 10 blade is used for small incisions in skin and muscle and is often used in more specialised surgeries. The blade has a curved cutting edge with a flat back. It is used with handles number 3 or 7.
The no. 21 blade is used for major invasive procedures. It is a larger version of the no. 10, with a curved cutting edge and a flat, unsharpened back edge. It is used with a no. 4 handle.
The no. 22 blade is used for skin incisions in both cardiac and thoracic surgery. It is a larger version of nos. 10 and 21, with a curved cutting edge and a flat, unsharpened back edge. It is used with a no. 4 handle.
The no. 36 is a larger blade used in general surgery, but also within a laboratory setting for histology and histopathology. It is used with a no. 4 handle.
03.01.07 Practise Mounting & Removing a Blade (Reusable Scalpel)
Use a sterilised handle and a sterile disposable blade. Open the blade by peeling apart its sterile packet, using a no-touch technique.
Beware of cutting yourself when fitting the blade to the handle. Hold the blade with a haemostat (artery forceps), never with your fingers.
To mount the blade, hold the blunt edge with artery forceps and slide the blade down over the scalpel handle's tongue until it snaps home.
To remove the blade, grasp the flange furthest from the point with the haemostat and gently disengage it from the scalpel handle's tongue.
Remove the blade facing down onto an instrument trolley or into a suitable container to avoid risk of injuring yourself, patient or assistant.
Dispose of the blade in a sharps container.
03.01.08 Things to Avoid - Handling Unsafely
Every healthcare setting will have a Sharps Safety Policy covering the handling of scalpels. This must be observed at all times. Never risk cutting yourself by using your fingers to mount or remove a scalpel blade. Always use artery forceps to grasp the blade.
When passing a scalpel, never pass it blade first, but handle first with the blade facing downwards. The safest way is to always put the scalpel in a kidney dish to pass it. Always replace the scalpel in the kidney dish when you have finished making your incision.