Surgical scissors are excellent surgical instruments for cutting and for blunt cutting. Most folks are right-handed which is why many surgical scissors are created by the manufacturing company this way. The thumb-ring finger grip provides the greatest stability in direction control and gives maximal closing, shear and torque forces with a natural grip-ping movement of the right hand.
For the greatest movement, have a neutral hand postion of the surgical scissors in all directions. The hand has minimal maneuverabilty & can rotate freely around the prone postion.
Surgical scissors can cut flaccid tissue effectively since the tissue is stabilized between the scissor blades. Surgical scissors cutting employs closing power, torque and shear to give an exact cut. When you push slice you give a more smooth cut along the surface. "chewing" happens when you jagged and crusehd wound stuck between the blades of surgical scissors lacking in cutting force.
While cutting sutures with the scissor tips, look for the knot between the slightly spread blades, instead than underneath the surgical scissors. Try the left hand, someone else, or another stable structure as a fulcrum to steady the scissors when making delicate cuts or when held by antoher person cutting sutures. When cutting a row of sutures, place the structure in your left hand so that each one becomes taut as you cut it & so that the cut sutures are put out of the way.
Blunt cutting can be achieved by spreading scissor blades between tissue planes or by using the surgical scissors as a probe or rake. Blind dissection is sometimes useful between tissue planes away from vital structures.
for better maneuverabilty and visibilty use curved scissors, whereas straight surgical scissors provide the greatest mechanical advantage when cutting tough, thick tissue.
Surgical scissors should be used to provide the most accuracy & control for the maneuver performed. Surgical scissors can be used for sharp cutting and for blunt dissection.
Surgical scissors are designed so that 3 force vectors are used in cutting: closing, shearing and torque. You then want to switch the forces from the hand to the shanks, then through a fulcrum to the cutting edges. The way the blades come together is by the closing force. Shearing is the force that pushes one blade flat up against the other while closing. Torque is when you use a motion to bring together the blade to touch the other blade. Most surgical scissors are made so that the gripping motion of the right hand effectively combines these forces to result in precise cuts.
When cutting, for correct control & direction, its crutial to make certain the tissue is correctly positioned between the two blades and The more wide the scissors are opened & the more close the tissue is to the fulcrum, the more upon this. when the blades gently push the tissue away, bunching it ahead of the shearing action of the blades. When you cut be sure to include an obtuse type of angle between the blades. The less the surgical scissors steady the tissue, then the less accurate the cut.
The grip that makes the best use of your surgical scissor design to give the three force vectors will result in crisp, clean cuts. Surgical scissors are most frequently held with the tips of the thumb and ring finger through the finger rings and your index finger places near the fulcrum on the shanks. This grip provides the largest "tripod" & therefore gives the best stability for direction control. The, torque and closing forces; this is the grip which provides it much better control. The thumb & middle finger grip which allows your index finger a better support on both sides of the shanks. This 3-point grasp tip will provide you a more tiny tripod as opposed to the previous way, there by making it slighty unstable.
Hold the surgical scissors in a cutting motion leaning forward, use your thumb-index grip. Such a grip uses only two-point direction control, this could casue an user to go off course. Though closing force is strong, doing this sort of gripping makes the minimal torque strength and shearing able to cut forward. With less shear & torque the blades will tend to "chew" rather than cut thick tissue cleanly.
The thumb-index finger grip used for cutting in a reverse direction. Such a grip applies three-point direction control with good lateral stability, however the torque force is nonexistent as well as the torque force, this reverse direction grip's main advantage lies in push cutting toward the operator.
The backhand grip is kind of a slight variation in the thumb-ring finger grip & is useful in cutting en route for the right.
All the grips we've covered thus far have a strong retracting force. the best grip is the thumb-ring finger for better direction, torque & shear forces. For reverse cutting, when your in direction control the grip is more stable. The prevouse 2 grips, when used in reverse cutting, you could lose control .
Surgical scissors isn't only a good medical tool for sharp cutting, surgical scissors with suitable tips are ideal for blunt dissection by spreading, ranking or probing. Surgical scissors have an added advantage over a clamp for blunt cutting, because alternating sharp & blunt dissection can be done without switching back and forth your surgical instruments. Blunt cutting spreads apart the layers of tissue. The cementing substance can be either scar tissue from a prior surgery or normal areolar tissue as in between fascial layers.
In the blunt cutting of layers bound by scar tissue you will come across hazard where the scar tissue traverses the cut in 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. Some scars could bring together bowel & fascia or parietal pericardium with bigger tensile strength to the heart than is present in the bowel or in the interior the myocardium. Blunt dissection in these cases may be inappropriate & result in an unintended enterostomy or entrance into the myocardium. It is therefore hazardous for blunt dissection where old scars traverse natural planes or where you see tough scar tissue already formed which is more compact than the structure.
Usually when surgeons cut using surgical scissors its in direct view. Blind scissors cutting & blunt dissection can sometimes be of enormous advantage & could be accurate & secure. Sometimes blind dissection is done in between the tissue planes in the anatomic regions away from such critical structures as big vessels & nerves. Blind surgical scissor dissection is an excellent method for opening a tunnel just beneath the dermis to put in a heterograft when you make an arterial venous fistula.
Blind surgical scissor dissection can also be put to advantage while doing a breast biopsy through a small circumareolar incision. It's hard to notice a deep side of a breats lump; but, by palpation, using the left index finger as a guide, surgical scissors could be used to circumscribe & remove the lump.
While exposing major blood vessels by blunt dissection with scissors, be sure to express caution when performing this, because you could tear branches and small tributaries. If you use your surgical scissors to make a spread between a major vessel, be sure to focus and not make any tearing of side branches; if you spread perpendicular to the great blood vessel; direct your attention plaques. Both methods, through having drawbacks, can be used if the inherent problems are understood.
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