One of the oldest surgical instruments used even today is a Scalpel (Surgical Blade with a Bard Parker Handle). Long before using metals in manufacturing, parts from various flora and fauna were used in making incisions during surgeries.
From time immemorial, several tools have been used in place of the surgical blade to include:
- Finger nails (especially during infant circumcision)
- Shark teeth – for venesection
The first recorded circumcision was carried out around 800 B.C using stones such as flint and jade, whose edges have been modified sharp. In 3000 B.C Obsidian knives were found in a turkish settlement which history suggests were used as a surgical instrument in brain surgeries.
In 400 BC, Hippocrates described the first scalpel in surgical use as a “Macairion”. This word is derived from “machaira”, a Lacedaemonian sword from the time. Roman medicine followed in the footsteps of Hippocrates, and they were particularly proficient in making cutting surgical instruments around 260B. The similar surgical instrument was named as “Scallepellus” by the Romans which was modified into the present-day word that we use as a “Scalpel”.
For a long time after, surgical knives with one straight edge and the other a sharp, cutting blade were used. Surgical instruments were manufactured by cutlery houses, and with poor hygiene conditions, the same knife would be used repeatedly.
ERA OF DISPOSABLE SURGICAL INSTRUMENTS – BLADES
The concept of Asepsis and sterilization led to more changes in the material and structure of the scalpel. The modern surgical scalpel with a disposable blade was inspired by King Gillette’s invention of the safety razor in 1904. Morgan Parker patented the two-piece scalpel with a handle and removal blade in 1915, which provided stability whilst still being able to exchange blades between uses. Scalpel blades were most often exchanged with fingers, or other surgical tools such as forceps.
Scalpel handles are known as “B.P handles”, after Morgan Parker and his business partner Charles Russel Bard. They were the founder of the Bard-Parker Company, which developed a cold sterilization method to prevent the dulling of blades that occurred during heat sterilization.
Most surgical scalpels were made of nickel or chromium-plated carbon steel until around 70 years ago. Stainless steel took over, as it was a “harder” surgical instrument material which was resistant to corrosion.
Modern evolution has polymer, chromium and diamond coating to improve the sharpness of the blade.
Today, surgeons are still using the 2-piece surgical scalpel. There are over 30 varieties of scalpel blades used, and the B.P handle also comes in various sizes. There have been various “safety scalpels” which have been introduced in the past two decades, though surgeons report that they still prefer the stainless steel traditional surgical scalpel.
The use of forceps or fingers to remove scalpel blades is still a shocking trend in hospitals, which can contribute to the 1000 scalpel blade injuries each year. To combat scalpel blade injuries, ORs are recommended to combine a hands-free-passing-technique with a single-handed blade removal system, such as Qlicksmart’s BladeFLASK blade remover, among other ones we shall mention later on.
TYPES OF BLADES/HANDLES
There are various types of blades with different sizes and shapes which are labelled with numbers depending on the surgeries to be done and location of an incision.
Each of them has a compatible BP Handles. BP Handles are also numbered based on their size. Let’s quickly talk about them:
- Handle No. 3 is compatible with Blade No. 10, 11, 12 and 15. It is the most common handle used in making incisions. A subtype No. 3G has a graduated scale present over the handle to measure structures. Another subtype No. 3L is a longer version of No. 3
- Handle No. 4 is compatible with Blade No. 20, 21, 22, 23 and 26. It is similar to No. 3 but has a larger tip for accommodation of large blades. No. 4G has graduations along the handle No. 4L is a longer version of No. 4.
- Handle No. 7 is compatible with Blade No. 10, 11, 12 and 15. It is a long and slender handle with is useful in making incisions in deep and tight spaces
Now the blades as a surgical instrument
The anatomy of the surgical blade –
- Sharp edge: Belly
- Unsharpened ridge opposite to the edge: Spine
- Slot for scalpel
Tips to remember blades
Blade #11 – Straignt and Pointed like number “1”
- Used for stab incisions (like in abscess drainage) because of it’s pointed tip.
Blade #12 – Edge is curved like number “2”
- Enables surgeon to make incision in inaccessible areas.
Blade #15 – Edge is curved like alphabet “S” or number “5”
- Used for making short, precise (finer) incision.
Blade #10 – The edge or belly is round like number “0”
- Used for cutting tissues.
Blade #20, 21 – This is like Blade #10 but larger in size Used for cutting soft tissues and covering large distance during initial skin incision.
USE OF SCALPEL
The scalpel as said before is used in making the incisions, one of the first and the essential instruments used in the Operation Theater. It can be held in different ways based on the type of incision needed.
- Palmar Grip – Here it is held between the thumb and the middle, ring and 5th fingers with the index finger over the upper border of the handle. The handle lies clutched in the palm. This grip is used while making incisions on tough tissues. A Periosteal Elevator is also held in a similar manner. The movement in this position arises from the shoulder.
Pencil Grip – Here it is held as a pencil which is used in making small, precision cuts where handle lies over the palm. In this position movement is given from the fingers to make fine cuts.
Finger-Tip Grip – A modification of Palmar grip where the scalpel is held with the fingertips and the handle lies under the palm. Here more length of blade lies in contact with the skin hence used in making long incisions, usually the on the skin.
Stab Grip – A modification of Pencil grip where the scalpel is held at a 90o angle to the skin surface. This position help in allowing maximum control over penetration into the surface. It is used while making ports for laparoscopic surgeries.
SURGICAL INSTRUMENTS SHARPS DISPOSAL METHODS AND INNOVATIONS
- Blades being sharps need to be discarded carefully, an attempt must be made to segregate them as soon as their purpose is completed. They must be put in a white plastic container with a black lid which would be sent to incineration. The handles may be reused after adequate sterilization.
- There are several blade removers available and some of them are mentioned here:
1. Swann-Morton Blade Remover Unit
2. The Qlicksmart BladeFLASK , single handed
3. Scalpel Blade Remover (Hu-Freidy)
4. Qlicksmart BladeSINGLE
5. Scalpel Blade Remover by PDMedical (double handed)
6. Mopec Aunex Scalpel Blade Remover
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