A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various handicrafts. A lancet is a double-edged 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.

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.

Alternatives to scalpels in surgical applications include electrocautery and lasers.

History edit

A lancet belonging to Edward Jenner

Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.[1] Skulls from the same time and place show signs of brain surgery.[2]

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.[3] The amphismela was an anatomical knife-edged on both sides. The term comes from the Greek αμφι (utrinque, "on both sides"), and μελιζω (inside, "I cut").[4]

Ancient Romans used more than 150 different surgical instruments, including scalpels.[5]

10th century Arab-Spanish surgeon Albucasis invented a retractable scalpel.[6]

The French used an amphismela in the 1700s.[7]

South African scientists showed that a blunt scalpel caused sharp cuts if the blade was subjected to ultrasound.[8] Applications might be in energy-saving paper cutting.[9]

Operation edit

Palmar grip
Pencil grip

In the 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.

In the 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.

Types edit

Surgical edit

Reusable scalpel handles
Disposable scalpels

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).

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.[10]

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.

A lancet has a double-edged blade and a pointed end for making small incisions or drainage punctures.

Handicraft edit

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.

Blades edit

Some of the scalpel blade types used for surgery
Types of surgical scalpel blades
Blade no. Picture Compatible handles Blade description Uses
No. 6 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 9 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 10 B3, 3, 3 Graduated, 3 Long, 5, 7, 9 Curved 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. 10a   B3, 3, 3 Graduated, 3 Long, 5, 7, 9 This blade is a small and straight
No. 11   B3, 3, 3 Graduated, 3 Long, 5, 7, 9 Triangular blade with sharp point, flat cutting edge parallel to the handle and flat back For precision cutting, stripping, sharp angle cuts and also stencil cutting due to its similarity to the X-Acto artknife blade
No. 11P B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. E11 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. E/11 B3, 3, 3 Graduated, 3 Long, 5, 7, 9 Debriding hard skin for example callus by Podiatrists.
No. 12   B3, 3, 3 Graduated, 3 Long, 5, 7, 9 A small, pointed, crescent-shaped blade sharpened on the inside edge of the curve
No. 12D B3, 3, 3 Graduated, 3 Long, 5, 7, 9 A small, pointed, crescent-shaped blade sharpened on both sides of the curve
No. 13 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 14 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 15   B3, 3, 3 Graduated, 3 Long, 5, 7, 9 A smaller version of the #10 For the same general use as the #10 blade
No. 15A B3, 3, 3 Graduated, 3 Long, 5, 7, 9 A front-facing straight blade with flat back
No. 15C B3, 3, 3 Graduated, 3 Long, 5, 7, 9 The #15 with a downward angle, flatter and thinner than the #15 The 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. 15T B3, 3, 3 Graduated, 3 Long, 5, 7, 9 Enucleation of lesions such as corns.
No. D/15 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. 16 B3, 3, 3 Graduated, 3 Long, 5, 7, 9 A narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handle For cutting stencils, scoring and etching
No. 17 B3, 3, 3 Graduated, 3 Long, 5, 7, 9 A flat face 1.6 mm chisel blade For narrow cuts
No. 18 4, 4 Graduated, 4 Long, 6 A 12.7 mm chisel blade For deep cuts and scraping
No. 19 4, 4 Graduated, 4 Long, 6 A similar blade to the #15
No. 20   4, 4 Graduated, 4 Long, 6 A 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. 21   4, 4 Graduated, 4 Long, 6
No. 22 2, 4, 5, 6 A 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. 22A 4, 4 Graduated, 4 Long, 6
No. 23   4, 4 Graduated, 4 Long, 6 Similar to #22, leaf-shaped For long incisions.
No. 24 4, 4 Graduated, 4 Long, 6 A wide, flat, angled cutting edge For corner cuts, trimming, stripping, and cutting mats and gaskets
No. 25 4, 4 Graduated, 4 Long, 6 A front-facing straight blade with flat back (similar to #15a)
No. 25a 4, 4 Graduated, 4 Long, 6 A triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26)
No. 26   4, 4 Graduated, 4 Long, 6 A triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a)
No. 27 4, 4 Graduated, 4 Long, 6
No. 34 4, 4 Graduated, 4 Long, 6 A triangular blade similar to the #11
No. 36 4, 4 Graduated, 4 Long, 6 A larger blade Used in general surgery but also within a Laboratory setting for Histology and Histopathology
No. 40 B3, 3, 3 Graduated, 3 Long, 5, 7, 9
No. PM40 Stainless PM Handle
No. PM40B Stainless PM Handle
No. 60 4, 4 Graduated, 4 Long, 6 A long blade resembling the #10 with a long cutting edge, rounded tip and flat back.
No. PM60 PM8
No. PM60B PM8

Safety edit

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.[11] 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.[12][13]

"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.[14]

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.[15]

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 [who?] 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.[clarification needed] Safety scalpels are active devices and therefore the risk of not activating is still significant.[16] There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.[17][full citation needed]

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.[18] 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.[19]

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.[18] It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.

See also edit

  • Laser scalpel – Medical use of laser to cut tissues
  • Medical device – Device to be used for medical purposes
  • The Lancet – Peer-reviewed general medical journal

References edit

  1. ^ Jo Marchant. "Scalpels and skulls point to Bronze Age brain surgery". New Scientist.
  2. ^ "ARTS-CULTURE – Excavations restarting at İkiztepe in northern Turkey".
  3. ^ Ochsner J (2009). "Surgical Knife". Tex Heart Inst J. 36 (5): 441–3. PMC 2763477. PMID 19876423.
  4. ^   This article incorporates text from a publication now in the public domainChambers, Ephraim, ed. (1728). "Amphismela". Cyclopædia, or an Universal Dictionary of Arts and Sciences (1st ed.). James and John Knapton, et al.
  5. ^ "Roman ruins cast new light on a trip to doctor". Telegraph.co.uk. December 9, 2007.
  6. ^ Ahmadi, Seyedeh Aida; Zargaran, Arman; Mehdizadeh, Alireza; Mortazavi, Seyed Mohammad Javad (2013-04-21). "Remanufacturing and Evaluation of Al Zahrawi's Surgical instruments, Al Mokhdea as Scalpel Handle". Galen Medical Journal. 2 (1): 22–25. doi:10.31661/gmj.v2i1.42. ISSN 2322-2379. S2CID 245939350.
  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". The American Journal of the Medical Sciences. 32 (16). Elsevier BV: 428–429. doi:10.1097/00000441-184816320-00026. ISSN 0002-9629.
  8. ^ Carlson CS, Pohl A, Keir D, Postema M (2020). "Cutting edge technology: sound sharpens the blade". Applied Acoustics. 166: 107336. doi:10.1016/j.apacoust.2020.107336. S2CID 216197723.
  9. ^ Shava KL, Hlakudi C, Postema M, Carlson CS (December 2021). Finetuning a single-blade sonic paper-cutter as an energy-saving sharpening instrument. International Conference on Electrical, Computer and Energy Technologies. Cape Town, South Africa. p. 9698577. doi:10.1109/ICECET52533.2021.9698577. ISBN 978-1-6654-4231-2. S2CID 246751942.
  10. ^ Ochsner, J (2009). "Surgical knife". Texas Heart Institute Journal. 36 (5): 441–443. PMC 2763477. PMID 19876423.
  11. ^ 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.
  12. ^ Perry J, Parker G, Jagger J (2003). "EPINet Report: 2001 Percutaneous Injury Rates". Advances in Exposure Prevention. 6 (3): 32–36.
  13. ^ "Sharps Injury Prevention Workbook". Cdc.gov (Centre for Disease Control and Prevention).
  14. ^ 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.
  15. ^ Arindam, Bit (22 June 2018). Design and Development of Affordable Healthcare Technologies. IGI Global. p. 29. ISBN 978-1-5225-4970-3.
  16. ^ 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.
  17. ^ "Needlestick and Sharp-Object Injury Report. US EPINet Network". Advances in Exposure Prevention. 7 (4): 44–45. 2005.
  18. ^ a b 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.
  19. ^ "OSHA Standard Interpretations – Use of passing trays and single-handed scalpel blade remover in a surgical setting". Occupational Safety and Health Administration. December 22, 2005.

External links edit