Cutting instruments must be sharp, and maintained so that they remain sharp. Wounds heal side to side, so an adequately sized incision does not extend the time for healing and may lower it by allowing easy visualisation of structures without the need for traumatising tissue by stretching and tearing.
Methods of cutting:
- Scalpel: usually skin incisions will be made with a scalpel blade. This is the least traumatic means of creating an
incision, because scalpels cause minimal tissue damage. Marked haemorrhage can be associated with this method due to the lack of stimulation for platelet action and the absence of crushing of small blood vessels, but healing will be rapid. - Scissors: these crush tissue more than a scalpel and may result in a delay to healing when wound edges are sutured. This crushing action does mean that there is less haemorrhage associated with the use of scissors to incise tissues.
- Electroincision: e.g. diathermy, this method uses electrical current to disrupt tissue by heating. This cauterises at the same time creating a bloodless field, but traumatising surrounding tissues more than the use of a scalpel.
Dividing deeper tissues
This is done by dissection. Dissection can either be sharp (and employ one of the above methods) or blunt, which allows separation of tissues without risk of damage to nerves or blood vessels and tends to respect tissue planes. The points of round-ended scissors are used to spread tissue and to separate it into distinct layers (without cutting) and these layers may then be cut with the blades. Tissue may be held during this process with thumb forceps. Different types of forceps produce varying degrees of tissue trauma. Tissues should be grasped gently, it is better to hold tissue that is to be removed and discarded in preference to
When manipulating tissue the surgeon’s fingers are considered to cause less trauma than instruments particularly, for example, when handling the