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A scalpel or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various . A lancet is a double-edged scalpel.
Scalpel blades are usually made of hardened and tempered steel, stainless steel, or high carbon steel; in addition, titanium, Ceramic knife, 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 .
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. The amphismela was an anatomical knife-edged on both sides. The term comes from the Greek language αμφι ( amphi, "on both sides"), and μελιζω ( inside, "I cut").
Ancient Romans used more than 150 different surgical instruments, including scalpels.
10th century Arab-Spanish surgeon Albucasis invented a retractable scalpel.
The French used an amphismela in the 1700s.
South African scientists showed that a blunt scalpel caused sharp cuts if the blade was subjected to ultrasound. Applications might be in energy-saving paper cutting.
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.
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.
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.
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.
| + Types of surgical scalpel blades |
| Generally for making incisions in skin and muscle. Commonly used to cut the skin in General surgery. |
| For precision cutting, stripping, sharp angle cuts and also stencil cutting due to its similarity to the X-Acto artknife blade |
| Debriding hard skin for example callus by Podiatrists. |
| For the same general use as the #10 blade |
| 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. |
| Enucleation of lesions such as corns. |
| For cutting stencils, scoring and etching |
| For narrow cuts |
| For deep cuts and scraping |
| Used in general surgery and orthopaedic surgery. |
| Used for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery. |
| For long incisions. |
| For corner cuts, trimming, stripping, and and gaskets |
| Used in general surgery but also within a laboratory setting for histology and histopathology |
"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.
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.
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.
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.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. 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.
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. It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.
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