Scalpel

A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (either called a hobby knife or an X-acto knife.). Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a utility knife) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile. Double-edged scalpels are referred to as "lancets".

Scalpel
Various scalpels. The first (from left), second, and fourth have replaceable blades. The fifth is a lancet.
ClassificationCutting tool
Used withStencil, surgery
RelatedLancet, utility knife, laser scalpel

Scalpel blades are usually made of hardened and tempered steel, stainless steel, or high carbon steel; in addition, titanium, ceramic, diamond and even obsidian knives are not uncommon. For example, when performing surgery under MRI guidance, steel blades are unusable (the blades would be drawn to the magnets and would also cause image artifacts). Historically, the preferred material for surgical scalpels was silver. Scalpel blades are also offered by some manufacturers with a zirconium nitride–coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut. Alternatives to scalpels in surgical applications include electrocautery and lasers.

Surgical scalpels
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Reusable handle (top) and disposable scalpels (bottom)

Surgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (sometimes just for a single, small cut).

A lancet belonging to Edward Jenner

The handle is also known as a "B.P. handle", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented the 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used.[1]

The handle of medical scalpels come in several basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle is larger than a #3. #5 handles are also common, and are round, with a patterning to ensure a non-slip grip. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle. The following table of blades is incomplete and some blades listed may work with handles not specified here.

Types of blades
Types of surgical scalpel blades
Blade No.PictureCompatible HandlesBlade DescriptionUses
No. 6B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 9B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 10B3, 3, 3 Graduated, 3 Long, 5, 7, 9Curved cutting edge with an unsharpened back edge. A more traditional blade shape.Generally for making incisions in skin and muscle. Commonly used to cut the skin in abdominal operations.
No. 10aB3, 3, 3 Graduated, 3 Long, 5, 7, 9This blade is a small and straight
No. 11B3, 3, 3 Graduated, 3 Long, 5, 7, 9Triangular blade with sharp point, flat cutting edge parallel to the handle and flat backFor precision cutting, stripping, sharp angle cuts and also stencil cutting due to its similarity to the X-Acto artknife blade
No. 11PB3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. E11B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. E/11B3, 3, 3 Graduated, 3 Long, 5, 7, 9Debriding hard skin for example callus by Podiatrists.
No. 12B3, 3, 3 Graduated, 3 Long, 5, 7, 9A small, pointed, crescent-shaped blade sharpened on the inside edge of the curve
No. 12DB3, 3, 3 Graduated, 3 Long, 5, 7, 9A small, pointed, crescent-shaped blade sharpened on both sides of the curve
No. 13B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 14B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 15B3, 3, 3 Graduated, 3 Long, 5, 7, 9A smaller version of the #10For the same general use as the #10 blade
No. 15AB3, 3, 3 Graduated, 3 Long, 5, 7, 9A front-facing straight blade with flat back
No. 15CB3, 3, 3 Graduated, 3 Long, 5, 7, 9The #15 with a downward angle, flatter and thinner than the #15The downward angle makes this the preferred blade for working within the chest during cardiac surgery, and is commonly used to make the distal arteriotomy during coronary artery bypass grafting.
No. 15TB3, 3, 3 Graduated, 3 Long, 5, 7, 9Enucleation of lesions such as corns.
No. D/15B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 16B3, 3, 3 Graduated, 3 Long, 5, 7, 9A narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handleFor cutting stencils, scoring and etching
No. 17B3, 3, 3 Graduated, 3 Long, 5, 7, 9A flat face 1.6 mm chisel bladeFor narrow cuts
No. 184, 4 Graduated, 4 Long, 6A 12.7 mm chisel bladeFor deep cuts and scraping
No. 194, 4 Graduated, 4 Long, 6A similar blade to the #15
No. 204, 4 Graduated, 4 Long, 6A larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back edge.Used in general surgery and orthopaedic surgery.
No. 214, 4 Graduated, 4 Long, 6
No. 222, 4, 5, 6A slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back edge.Used for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery.
No. 22A4, 4 Graduated, 4 Long, 6
No. 234, 4 Graduated, 4 Long, 6Similar to #22, leaf-shapedFor long incisions.
No. 244, 4 Graduated, 4 Long, 6A wide, flat, angled cutting edgeFor corner cuts, trimming, stripping, and cutting mats and gaskets
No. 254, 4 Graduated, 4 Long, 6A front-facing straight blade with flat back (similar to #15a)
No. 25a4, 4 Graduated, 4 Long, 6A triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26)
No. 264, 4 Graduated, 4 Long, 6A triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a)
No. 274, 4 Graduated, 4 Long, 6
No. 344, 4 Graduated, 4 Long, 6A triangular blade similar to the #11
No. 364, 4 Graduated, 4 Long, 6A larger bladeUsed in general surgery but also within a Laboratory setting for Histology and Histopathology
No. 40B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. PM40Stainless PM Handle
No. PM40BStainless PM Handle
No. 604, 4 Graduated, 4 Long, 6A long blade resembling the #10 with a long cutting edge, rounded tip and flat back.
No. PM60PM8
No. PM60BPM8

Gripping a medical scalpel
Palmar grip

Palmar grip

Also called the "dinner knife" grip. The handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.

Pencil grip
Pencil grip

Best used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle. The scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb. Care should be taken not to allow the handle to rest too far along the index finger as this promotes an unstable grip and cramped fingers.

Graphic design and arts and crafts blades
X-Acto knife

Graphical and model-making scalpels tend to have round handles, with textured grips (either knurled metal or soft plastic). The blade is usually flat and straight, allowing it to be run easily against a straightedge to produce straight cuts.

There are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for wood carving, cutting leather and heavy fabric, etc.

Historical scalpels
  • Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.[2] Skulls from the same time and place show signs of brain surgery.[3]
  • Ancient Egyptians made incisions for embalming with scalpels of sharpened obsidian, a material that is still in use.
  • The first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.[4] The amphismela was an anatomical knife, edged on both sides. The term comes from the Greek αμφι (utrinque, "on both sides"), and μελιζω (incido, "I cut").[5]
  • Ancient Romans used more than 150 different surgical instruments, including scalpels.[6]
  • Indian Ayurvedic medicine mentions the use of sharp bamboo splinters.
  • The French used an amphismela, an anatomical knife, edged on both sides, in the 1700s.[7] The term comes from the Greek αμφι (utrinque, "on both sides"), and μελιζω (incido, "I cut").[8]

Scalpel injuries
See also: Needlestick injury

Rising awareness of the dangers of sharps in a medical environment around the beginning of the 21st century led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the Centers for Disease Control and Prevention, as many as 1,000 people were subject to accidental needle sticks and lacerations each day in the United States while providing medical care. Additionally, surgeons can expect to suffer hundreds of such injuries over the course of their career.[9] Scalpel blade injuries were among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries made up 7 percent to 8 percent of all sharps injuries in 2001.[10][11]

"Scalpel Safety" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.[12]

Safety scalpels

Safety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act, which requires hospitals to minimize the risk of pathogen transmission through needle or scalpel-related accidents.[13]

There are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, DeRoyal, Jai Surgicals, Swann Morton, and PenBlade are more intuitive to use due to their similarities to a standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as Aditya Dispomed, Aspen Surgical and Southmedic. A few companies have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.

However, CDC studies shows that up to 87% of active medical devices are not activated. Safety scalpels are active devices and therefore the risk of not activating is still significant.[14] There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.[15]

Blade removers

There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.[16] There are companies which offer a single-handed scalpel blade remover that complies with regulatory requirements such as US Occupational Safety and Health Administration Standards.[17]

Safety

The usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.[16] It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.

See also

References
  1. Ochsner, J (2009). "Surgical knife". Texas Heart Institute Journal. 36 (5): 441–443. PMC 2763477. PMID 19876423.
  2. Jo Marchant. "Scalpels and skulls point to Bronze Age brain surgery". New Scientist.
  3. "ARTS-CULTURE – Excavations restarting at İkiztepe in northern Turkey".
  4. Ochsner J (2009). "Surgical Knife". Tex Heart Inst J. 36 (5): 441–3. PMC 2763477. PMID 19876423.
  5.  This article incorporates text from a publication now in the public domain: Chambers, Ephraim, ed. (1728). "Amphismela". Cyclopædia, or an Universal Dictionary of Arts and Sciences (1st ed.). James and John Knapton, et al.
  6. "Roman ruins cast new light on a trip to doctor". Telegraph.co.uk. December 9, 2007.
  7. Dunglison, Robley (October 1848). Art. XXVI.—Medical Lexicon. A Dictionary of Medical Science, containing a concise explanation of the various subjects and terms, with the French and other Synonymes, notices of Climate and of celebrated Mineral Waters. Formaiœ for various officinal and empirical Preparations, etc. Vol. 32. Elsevier BV. pp. 428–429. doi:10.1097/00000441-184816320-00026. ISSN 0002-9629.
  8.  This article incorporates text from a publication now in the public domain: Chambers, Ephraim, ed. (1728). "Amphismela". Cyclopædia, or an Universal Dictionary of Arts and Sciences (1st ed.). James and John Knapton, et al.
  9. Schoub, B. D. (10 June 1999). AIDS and HIV in Perspective: A Guide to Understanding the Virus and Its Consequences. Cambridge University Press. p. 114. ISBN 978-0-521-62766-5.
  10. Perry J, Parker G, Jagger J (2003). "EPINet Report: 2001 Percutaneous Injury Rates". Advances in Exposure Prevention. 6 (3): 32–36.
  11. "Sharps Injury Prevention Workbook". Cdc.gov (Centre for Disease Control and Prevention).
  12. Sinnott M.; Wall D. (2007). "'SCALPEL SAFETY': How safe (or dangerous) are safety scalpels?". International Journal of Surgery. 6 (2): 176–177. doi:10.1016/j.ijsu.2007.01.010. PMID 18442809.
  13. Arindam, Bit (22 June 2018). Design and Development of Affordable Healthcare Technologies. IGI Global. p. 29. ISBN 978-1-5225-4970-3.
  14. Alvarado-Ramy F, Beltrami EM, Short LJ, et al. (2003). "A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicentre study, 1993–1995". Infect Control Hosp Epidemiol. 24 (2): 97–104. doi:10.1017/S019594170008509X. PMID 12602691. S2CID 232178603.
  15. "Needlestick and Sharp-Object Injury Report. US EPINet Network". Advances in Exposure Prevention. 7 (4): 44–45. 2005.
  16. Fuentes, H., et al. (2008). "Scalpel Safety": Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries." The International Journal of Risk & Safety in Medicine 20(1–2):83–89.
  17. "OSHA Standard Interpretations – Use of passing trays and single-handed scalpel blade remover in a surgical setting". Osha.gov. December 22, 2005.
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