03.02 Handling of Instruments - Suture Scissors
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 suture scissors.
In this module
03.02 Suture Scissors
Suture scissors are sometimes referred to as dressing scissors. They are robust instruments with straight blades.
Several types are available. For general cutting of ties and sutures, most surgeons prefer Mayo scissors which have semi-blunt tips and are therefore less likely to accidentally damage other structures.
Sharp pointed scissors should only be used for removal of very fine sutures, where the semi-blunt ends of the Mayo scissors would not be able to get under the suture.
Suture scissors are not suitable for dissecting tissues, as using them on sutures tends to dull the blades.
03.02.01 Principles Video 1
To cut effectively, the scissor blades combine a parallel slicing action with a shearing action. The shearing requires a subtle opposing force by thumb and ring finger.
Cut with the tips of the scissors only.
If you are operating alone, it can be helpful to swivel the scissors round into your palm when not cutting, rather than putting them down between sutures.
03.02.02 Principles Video 2
Whilst left-handed scissors are available to buy, they are not included in standard instrument sets, and left-handed surgeons often lack access to them while training. A pair of right-handed scissors with good riveting may cut successfully in the left hand, but as the scissors become looser you are likely to experience problems and will need to use a different technique.
This is because the natural tendency of the left hand will be to force the blades laterally apart, and they will fail to cut. Your thumb will push down the lower part of the fulcrumed blade, so lifting up the upper part.
Your fingers will lift up the lower part of the other blade and therefore push down the upper part.
Furthermore, the cutting edge of the scissors will be behind the top blade, and you will not be able to see the cutting edge well enough to cut with accuracy.
By inverting your hand and holding the scissors differently as shown here, the scissor blades will now appose and cut successfully.
03.02.03 Practise Right Hand Hold & Control
Hold the scissors with your thumb in the upper finger hole and your ring finger in the lower one. Rest the scissors on your middle finger and, for better stability and control, place the index finger on the joint of the scissors.
Now try cutting. Use the tips of the scissors only.
Steady the scissors with your index finger while cutting.
Try swivelling the scissors round in your hand by releasing your thumb from the finger hole. This can be useful if you are suturing alone rather than putting them down between sutures.
Practise steadying the scissors further with your other hand. Rest the joint of the scissors on your opposite index finger for even more stability. Use the opposite index finger as a fulcrum.
03.02.04 Practise Left Hand Hold & Control
Invert your left hand and place the scissors in the palm. Hold one ring of the handles between your thumb and index finger. Place your middle finger in the other ring.
Close the scissors by squeezing the index and middle fingers together. Cut with your hand in this inverted position.
03.02.05 Things to Avoid
This section covers the most common problems encountered when learning to use suture scissors.
03.02.05.01 Failure to Cut
Scissors will fail to cut unless their shearing action is used. Using scissors with your non-dominant hand reverses the direction of the normal shearing force. Unless you are aware of this and consciously correct it, the scissors will fail to cut precisely.
03.02.05.02 Protruding Tips
If you allow the scissor tips to protrude beyond the suture, you risk inadvertently cutting other structures.
Sharp pointed scissors are only necessary for removal of very fine skin sutures. For cutting all other types of suture, Mayo scissors with semi-blunt tips are a safer option and will minimise the risk of accidentally cutting other structures.