Surgical scissors are excellent surgical instruments for disection & for blunt dissection. Most scissors are designed for use with the right-handed grip that enables direction control & precision of cuts. Having a thumb-ring grip gives the best control & movability that gives max closing, torque & shear force using your natural grip movement of your right hand.
Pronation to normal hand positions gives the greatest maneuverability of surgical scissors in different directions. The supinated hand can move only toward the prone position and therefore has limited maneuverability.
If the flaccid tissue us successfully placed correctly between the surgical scissors then it can be slice just fine. When surgical scissors cut, they give force, shear & torque to create an exact cut. Push-cutting allows straight cuts along the grain of a sheet of tissue. "chewing it" results in a jagged, crushed wound from tissue trapped between the blades of the surgical scissors lacking in shear and 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, hold the sutures in your left hand do this so the single one can "taut" as you cut it and they do this so that the cut sutures are held out of the way.
By spreading the scissors while inside the tissue planes, blunt dissection can be done or by doing a probe or rake by using surgical scissors. Its sometimes ok to do blind dissection when its useful in between tissue plane structures.
Curved surgical scissors offer greater maneuverability and visibility, Straight surgical scissors give the best possible mechanical advantadge when cutting through thick, tough skin.
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 mainly for blunt dissection & sharp cutting.
Most surgical scissors are designed & designed so that three force vectors are for to cut: shearing, torque and closing. These forces are transferred 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 when you blade the two blades flat up against each other. Mainly a cutting movement. Torque is the force that rolls the leading edge of each blade inward to touch the other. Alot of surgical scissor designers create these devices so when you move your hands in the right motion the cut automatically slices through perfectly.
In cutting, direction control & accuracy depend upon the stability of the tissue between the surgical scissor blades & the security of the operator's grip on the scissors and the closer the tissue is to the fulcrum, the more on this. The blades tend to push the tissue away, making a buncking effort of the slicing action. The more obtuse the angle between the blades when cutting. You will receive a non-accurate cut if try to steady the tissue, using the scissors.
To get a crisp, clean cut, try using the the grip that is designed to the three force vectors. Surgical scissors are most commonly held with the tips of the thumb and ring finger through the finger rings & with the index finger resting on the shanks near the fulcrum. This grip gives the largest type "tripod" and there by giving you the best direction for overall pivotial control. The normal grasping motion of this grip applies maximum shear, closing & torque forces; and is therefore the grip that gives maximum control. The middle finger and thumb grip which allows the index finger to be used to hold the sides of the shanks. The resulting three-point grasp creates a smaller tripod as opposed to the previous method, therefore, slightly less stable.
The thumb-index finger grip, with the surgical scissors held to cut in a forward direction. This grip uses only two-point direction control, this may casue a person to wonder off course. The force may be strong when closing, this grip applies the least shearing and torque forces of all grips possible for forward cutting. When you have the slightest torque & shear the blades may tend to make a choppy motion 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. This type of grip gives good three point directional control with a well lateral control, but the shear and torque forces are virtually nonexistent, this reverse direction grip's main advantage lies in push slicing toward the operator.
The backhand grip is really a slight variation in the thumb-ring finger grip and is useful in cutting toward the right.
All grips talked about up to this point provide strong closing force. The thumb-ring finger grip provides the best direction, shear and torque forces. If you cut backwards, the grip is most stable 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, for blunt dissection you may want to get the appropriate tips on the scissors by probing, spreading or ranking. For blunt cutting, surgical scissors have an added ability as opposite to a clamp, because switching back and forth from blunt cutting to sharp can be accomplished without changing surgical instruments. Blunt dissection separates tissue layers themselves. If you see any cementing substance it may be scar tissue from a previous surgery or normal areolar tissue as in between fascial layers.
In the blunt dissection of layers bound by scar tissue you will encounter hazard where the scar tissue traverses the cut in one of the layers. It's considered risky when the cutting between layers when the adhesions have more tensile strength than the bound layers. A scar may bind bowel to fascia or parietal pericardium to the heart with more tensile strength than is present within the bowel or within the myocardium. You may not want to use blunt dissection with your surgical scissors in this instance and can result in an unintended enterostomy or entry in the myocardium. This is why its risky for blunt cutting where you see some old scares come together with natural planes or where dense scar tissue is tougher than the structures it blinds.
Most blunt dissection and cutting with surgical scissors is under direct sight. Blind scissors cutting and blunt dissection can sometimes be of great advantage & may be accurate and secure. Such blind cutting is done between well-established tissue planes in anatomic regions far away from important structures like nerves and large blood vessels. To open up a tunnel beneath the dermis, you will want to use the blind surgical scissor dissection method to put in a heterograft when you make an arterial venous fistula.
You can also put blind surgical dissection to work in your favor while your doing a breast biopsy in a small cirumareolar incision. Often it is hard to see the deep side of a breast lump; but, by palpation, when you use a left pointer-giner as a guide, surgical scissors can be used to circumscribe & remove the lump.
When you expose major blood vessels by cutting, exercise caution to avoid contusing the vascular wall or tearing small tributaries & branches. If surgical scissors are used to spread parallel to a major vessel, concentrate on preventing any tearing of small side branches; whereas if spreading is done perpendicular to the great vessel; focus your full attention plaques. Both methods, do have setbacks, can be used if the inherent problems are understood.
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