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The Best Methods Of Grasping Surgical Scissors
Author : Marshall Black
Submitted : 2012-02-16 Word Count : 720 Popularity: Not Rated
Tags: surgical instruments, medical, forceps
In the ER, Sugical scissors are most commonly used for cutting. Most people are right-handed which is why most surgical scissors are designed by the manufacturing company this way. The thumb-ring finger grip provides the greatest stability in direction control and gives maximal closing, shear & torque forces with a natural grip-ping motion of the right hand.
For the biggest movabilty, have a neutral hand postion of the surgical scissors in all directions. The hand has minimal movement and can rotate freely around the prone postion.
If the flaccid tissue us successfully placed correctly between the surgical scissors then it can be cut just fine. When surgical scissors cut, they give force, shear and torque to produce an exact cut. Push-cutting allows straight cuts along the grain of a piece of tissue. "chewing" results in a crushed, jagged wound from tissue trapped between the blades of the surgical scissors lacking in shear & torque forces.
When your cutting sutures with your scissor tip, seek out for the knot in between the slightly spread blades, as opposed to under your scissors. Use the left hand, the patient's body, or some other structure thats stable be sure to steady the scissors when you do a delicate cut or when cutting sutures held by another person. When your cutting a row of sutures, place the structure in your left hand do this so the single one can "taut" as you cut it and they do this so that the slice sutures are held out of the way.
Blunt dissection can be done by spreading scissor blades between tissue planes or by using the surgical scissors as a probe or rake. Its sometimes ok to do blind cutting when its useful in between tissue plane structures.
for better maneuverabilty & visibilty use curved scissors, whereas straight surgical scissors provide the greatest mechanical benefit when cutting tough, thick tissue.
When looking for the primary surgical scissors the market has to offer. One should keep in mind that control & maneuverability are crucial. These scissors are primary for blunt dissection & sharp cutting.
Most surgical scissors are made & designed so that three force vectors are for to cut: torque, closing and shearing. You then want to switch the forces from the hand to the shanks, and then get a fulcrum to the cutting edges. The closing force is that what causes the blades to come together. Shearing is the force that pushes one blade flat against the other while closing. Torque is when you use a movement to bring together the blade to touch the other blade. Most surgical scissors are created so that the grasping motion of the right hand successfully combines these forces to result in precise cuts.
In cutting, direction control and accuracy depend on the stability of the tissue between the surgical scissor blades & The more wide the scissors are opened & the closer the tissue is to the fulcrum, the more on this. The blades tend to push the tissue away, bunching it ahead of the shearing action of the blades. When cutting be sure to include an obtuse type of angle between the blades. You will receive a non-accurate cut if try to stabilize the tissue, using the scissors.
The grip that makes the best use of your surgical scissor design to apply the three force vectors will result in clean, crisp cuts. The most familar and greatest way to have these surgical instruments is by putting your ring finger through the rings and the ends of your thumbs holding the medical instruments & your index finger places near the fulcrum on the shanks. This grip gives the biggest type "tripod" & there by giving you the best direction for overall pivotial control. The normal grasping motion of this grip applies maximum shear, torque & closing forces; and is therefore the grip that gives maximum control. The thumb & middle finger grip which gives your index finger a better support on both sides of the shanks. The resulting 3 point grasp makes a smaller tripod than the previous method and is, there by getting it slighty unstable.
The thumb-index finger grip, with the surgical scissors held to incise in a forward direction. A grip like this, uses something called two-point direction control, which can allow a cut to go off course. The force can be strong when closing, doing this type of gripping makes the least torque strength and shearing able to cut forward. When you have less torque and shear the blades may tend to make a choppy movement in the cut like it was chewed as opposed to a nice clean cut.
To cut in an opposite direction use the thumb-index finger grip. Such a grip applies 3 point direction control with good lateral stability, however the torque force is nonexistent as well as the torque force, this way will need push cutting as a primary method.
All grips discusses to this point provide strong closing force. the best grip is the thumb-ring finger for better direction, torque & shear forces. If you cut backwards, the grip is most secure in direction control. The other two grips, if used in reverse cutting, lose their directional stability.
As well as being a great medical tools for sharp cutting, surgical scissors with proper tips are ideal for blunt dissection by ranking, probing or spreading. For blunt cutting, surgical scissors have an extra ability as opposite to a clamp, because switching back and forth from blunt cutting to sharp can be accomplished without changing medical instruments. Blunt dissection separates tissue layers themselves. If you see any cementing substance it may be normal areolar tissue, as between fascial layers, or scar tissue from previous surgery.
Be cautious of obsacules when slicing through the differnet sections of scar tissue, espically where the scar tissue comes in together with one of the layers. Blunt dissection of adhesions between layers proves risky when you have more tensile strength than the bound layers of the adhesions. A scar may bind bowel to fascia or parietal pericardium with larger tensile strength to the heart than is present within the bowel or within the myocardium. Blunt dissection in these cases may be unnecessary and can result in an unintended enterostomy or entry in the myocardium. It is therefore dangerous for blunt cutting where former scars traverse natural planes or where you see tough scar tissue already formed which is more dense than the structure.
Usually when doctors cut using surgical scissors its in direct view. Blunt dissection and blind cutting could be useful, secure and accurate. Sometimes blind dissection is done in between the tissue planes in the anatomic regions away from such critical structures as big vessels and nerves. To open up a tunnel beneath the dermis, you will want to use the blind surgical scissor dissection method to insert a bovine heterograft when creating an arterial venous fistula.
Blind surgical scissor dissection can also be put to your benefit while your doing a breast biopsy in a tiny cirumareolar incision. Often it is difficult to see the deep side of a breast lump; but, by palpation, using the left index finger as a guide, scissors could be used to circumscrive and get rid of the lump.
While exposing major blood vessels by blunt cutting with scissors, exercise care to avoid contusing the vascular wall or tearing tiny tributaries and branches. If you use your surgical scissors to make a spread between a major vessel, be sure to focus & not make any tearing of side branches; whereas if spreading is done perpendicular to the great vessel; direct your attention plaques. Both methods, do have setbacks, could be used if only the promblems are understood.
Author's Resource Box
This editorial is by Sean Z.
Sources: Surgical Blog, A Medical Source, Dilator Blog, Surgical Instrument Sets, Medical Instrument Blog, A Surgical Instruments Source.
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