Scalpels and dissectors

A sharp scalpel cuts tissue with less trauma than any other instrument. There are two ways of holding one: (1) If you need force to make a big bold cut, grasp it with your index finger along the back, as in Fig. 4-1. (2) If you want to cut more gently, hold it like a pen. The size of a blade does not change the way you use it, but its shape does. A small blade allows you to make precise turns. Stab the point of a No.11 blade into an abscess and then sweep it upwards in an arc. Experienced surgeons do a lot of knife dissection beginners find other instruments safer for many purposes.

SCALPEL, solid forged, size No.1, 30 mm, and size No.5, 40 mm, two scalpels only of each size. If your disposable blades are exhausted, you can use a solid scalpel and resharpen it (Appendix A), whereas you cannot resharpen a disposable blade. A solid blade is essential for symphysiotomy (18.4).

HANDLE, scalpel, Bard Parker, No.4, eight only. This is the standard handle for blades 20, 21, 22, 23, and 24. Get good quality handles, because poor ones may not fit the blades.

HANDLE, scalpel, Swan Morton, No.5, four only. This long elegant handle fits blades 10, 11, 12, and 15.

BLADES, scalpel, disposable, Bard Parker or Swann Morton type, stainless steel in dispenser containing 100 blades. (a) Type 10, ten dispensers only. (b) Type 11, five dispensers only. (c) Type 15, five dispensers only. (d) Type 22, two dispensers only. (e) Type 24, two dispensers only. The medium-sized curved blade 10, the small curved blade 15, and the pointed blade 11, all fit into the long No.5 blade holder. The big curved blades 22 and 24 fit into the standard No.4 handle. If necessary, you can autoclave these blades and use them for 3 or 4 operations.

OILSTONE, hard Arkansas pattern, 150[mu]70[mu]30 mm, one only. Use this to sharpen scalpels and scissors. A very blunt instrument needs a carborundum stone first.

DISSECTOR, MacDonald, one only. A blunt dissector is often safer than a scalpel. This is a blunt general purpose dissector, with one straight flat end and one round curved end, neither of which are likely to injure anything.

Fig. 4-1 SCALPELS AND HOW TO USE THEM. The advantage of a solid forged scalpel is that you can resharpen it. You also need it for symphysiotomy.