What Is a Surgical Knife?

In the 2018 medical device classification catalog, the scalpel refers to a special knife composed of a blade and a handle for cutting human or animal body tissue, and is an indispensable and important surgical tool in surgery.

Chinese name: Scalpel
Foreign name: Scalpel
Make up: Blades and holders

Primary product category: Surgical instrument-knife
Secondary product category: Scalpel
Management category: Type (one-time sterile scalpel)
Management category: Class I (non-disposable and non-sterile)

History of scalpel development

The "Scythe" unearthed in the No. 4 tomb of Shang Dynasty Site in Taixi Village, Tancheng County, Hebei Province in 1973, has been verified by experts as the world's earliest scalpel, with a history of over 3400 years ^[1] . In the late 19th and early 20th centuries, with the improvement of anesthesia and blood transfusion technology, modern surgery has improved qualitatively, surgical instruments have been continuously improved, and the manufacturing process has also been greatly improved. The material has evolved from iron to stainless steel, titanium, and chromium. , Vanadium, etc.

Structure and use of scalpel

A scalpel usually consists of a blade and a handle ^[2] . The blade usually has a cutting edge and a mounting groove connected with the scalpel handle. The material is usually made of pure titanium, titanium alloy, stainless steel or carbon steel, which is generally disposable. During dissection, the blade is used to cut open skin and muscle, the blade is used to clean blood vessels and nerves, and the handle is used for blunt separation. According to the size of the wound, choose the appropriate type of blade and knife handle. The common scalpel has the characteristics of zero damage to the tissue after cutting, so it can be applied to various surgeries, but the wound bleeding after cutting is active, and it should be used in a controlled manner in surgery with more bleeding.

Scalpel classification

According to the connection form of the blade and the handle, it can be divided into two types: detachable scalpel and fixed scalpel. Among them, the application of detachable scalpel is more common.

Model of scalpel

Tool holder model

The common ones are No. 3, No. 3 extension, No. 4, No. 4 extension, No. 7, No. 9, 18CM upturn, 18CM downturn (its model is engraved at its end).

Scalpel

2. Blade model

Commonly used are 10-27, 34, 36 (the model is engraved on its root).

Scalpel_Blade

3. Purpose

Generally, No. 10 and No. 20-24 blades are used to cut skin, subcutaneous, muscle, periosteum and other tissues; No. 11 blades are used to cut blood vessels, nerves, gastrointestinal tract and heart tissue; No. 12 blades are used for knee, For facial surgery; blade No. 15 is used for deep tissue and tissue cutting such as ophthalmology and coronary artery bypass grafting.

How to use a scalpel

Depending on the size and position of the incision, the position of the knife is divided into acupressure (also known as the piano or holding the bow), grasping (also known as the catching knife), writing and anti-picking (also known as outward writing). Hold the law.

Scalp position

1. Acupressure is the most commonly used method of scalpel operation. It exerts the strength of the wrist and fingers, and is mostly used for abdominal skin incision and cutting tissues.

2. The grip type is used to cut a wide range of hard tissues with large force, such as tendons, necrotic tissues, chronic proliferative tissues, etc. The strength is on the wrist.

3. The stylus type is used to cut short incisions. It is gentle and fine to operate, such as separating blood vessels and nerves and cutting the peritoneal orifice. The movement and strength are mainly on the fingers.

4. The anti-picking style is a conversion style of writing. The blade is protruded from the inside to the outside to avoid deep tissue or organ damage, such as peritoneal incision or the narrow tendon sheath.

Scalpel delivery method

The traditional delivery method is that the hand-washing nurse passes the blunt end of the scalpel handle to the operator during the operation. This method has certain safety risks and is likely to cause sharp injury. After the improvement, more delivery methods are used. Passed in the bend ^[3] .

How to install and remove the scalpel

Hold the end of the blade side of the handle with your left hand, hold the needle clamp (needle holder) with your right hand, and clamp the back side of the upper part of the blade hole at a 45 ° angle. Hold the handle with your left hand and align the hole with the downward force until the blade is completely Install on the handle; when removing, hold the surgical handle in your left hand, hold the needle holder in your right hand, clamp the back side of the end of the blade hole, lift it up slightly, and push it forward along the handle groove ^[3] .

Scalpel defect

1. The scalpels of the prior art have a single-edged structure. They cannot cut hard tissues such as bones, have poor hygiene, and are susceptible to cross infection.

2. Traditional scalpels only have anatomical functions, and tweezers are often used during the dissection. Repeated use of traditional scalpels and tweezers multiple times will prolong the anatomical time and reduce the anatomical efficiency. In the process of dissection, the problem of dark ambient light will be encountered, which will easily cause the wrong dissection of the anatomical base.

3. The scalpel lacks a protective cover for the blade, which is likely to cause damage to the blade and easy injury to the user.

4. The blade of the scalpel is the main working part and is subject to heavy wear. Once the blade is worn, the scalpel needs to be replaced, resulting in a waste of resources. If the blade is damaged during the dissection and cannot be replaced immediately, it will affect the dissection. Reduced anatomical efficiency.

5. The scalpel handle cleaning and disinfection device has the disadvantages of high manufacturing cost, complicated operation and low work efficiency ^[3] .

Cautions for scalpel

1. Each time the surgical blade needs to be sterilized and sterilized, you can use any of the methods of high-pressure steam sterilization, boiling sterilization, and immersion sterilization. The effect of boiling sterilization is very obvious, but one-time use is recommended. Medical surgical blade.

2. When the blade is matched with the handle, disassembly should be easy, and there should be no jamming, looseness or breakage.

3. During the transfer of the knife, do not point the blade towards yourself or others, to avoid injury.

4. Regardless of the method of holding the knife, the protruding surface of the blade should be perpendicular to the tissue, and the tissue should be cut layer by layer. Do not operate with the tip of the knife. The operation is too high and the control is unstable. Be moderate.

5. When doctors use a scalpel to perform surgery for a long time, they often have discomfort such as acidic sleep on the wrist, which can cause wrist strain. Therefore, it may adversely affect the effect of the operation and cause health risks to the doctor's wrist.

6. When cutting tissues such as muscles, blood vessels are often accidentally injured. In this case, it is necessary to rinse with water to find the bleeding site as soon as possible, otherwise it will cause serious difficulties in the normal operation of the surgery.