Which of the following forceps should be used to grasp delicate tissue Securly for control during dissecting?

Overview

• a common surgical tool for cutting or dissecting tissues.
• used to cut loose tissues, the blades stabilize the tissues during cutting
• provides very good control of depth and direction of cutting. 
• more traumatic than scalpel because they crush during cutting.

Goal

• contolled use of tissue scissors during scissor cutting, push cutting and blunt dissection

Skills to Practice

1. wide-based tripod grip
2. accurate scissor cutting
3. controlled push cutting
4. accurate, efficient blunt dissection 

Basics

• scissors are classified according to
  1. tips [sharp-sharp, blunt-blunt, sharp-blunt]
  2. blade shape [straight or curved]
  3. cutting edge [normal or serrated]

• blunt-blunt tips with a normal cutting edge are typically used
• straight scissors provide more mechanical advantage for cutting thick or tough tissue
• curved scissors allow greater maneuverability and visibility

• scissors come in a variety of sizes and designs depending on their intended use
• commonly used basic types include:

Mayo scissors

• sturdy design
• used to cut heavier tissues [eg. linea alba, thick fascia]
• [ memory tip: “short” name” → “short” handle]

Metzenbaum scissors

• • relatively finer design
  • used for fine tissues and blunt dissection [eg. subcutaneous and light fascia]
  • [ memory tip: “long” name”  → “long” handle]

General purpose ["suture"] scissors

• relatively shorter and broader blades
• commonly lower quality [cheaper] so can be frequently replaced as become dull or damaged
• used to cut sutures and other materials, NOT tissues
• preserves the sharpness of the tissue scissors

Holds

Wide based tripod grip

• most efficient hold
• thumb and ring finger through the rings
• middle finger is placed on top of the finger ring
• index finger is placed along handles towards fulcrum [improves control of tips]
• avoid putting fingers too far into rings as limits maneuverability and comfort [stay above first knuckle]
• avoid putting index or middle finger though ring as decreases stability and efficiency
• left-handed surgeons: most adapt to using scissors with right hand but left handed scissors are available

Backhand grip

• typically used for cutting from left to right [less awkward]
• thumb and middle finger through the rings with handle resting on third and fourth fingers

• can be modified when cutting fowards body
• thumb and index finger through the rings
• more comfortable efficient and controlled

How to Use

Scissor cutting

• more traumatic than scalpel but gives excellent control

Technique:

• blades partially closed over tissue and elevated slightly [stabilizes tissues]
• tips closed to cut the tissue
• only use the tips
  • more crushing trauma and jagged edges if entire blade used

When continuing an incision

• tips are not closed completely
• blades are re-opened, tips advanced and more tissue cut
• continues for entire incision length
• avoids creating a series of jagged cut

Push cutting

• efficient cutting method
• used for longer incisions in light fascia

Technique:

• begins with a scissor blades partially closed [tip still open]
• continue by pushing the nearly closed blade forward through the tissue
• tissue is cut in one continuous motion without further opening/closing of the blades
• scissors should advance easily without tearing the tissue or technique is abandoned

Blunt dissection

• used to separate fine tissue attachments between anatomic tissue planes and isolate delicate structures

  • nice for separating muscles, fat and fine fascial planes
  • more traumatic than sharp dissection [scalpel or scissor]
  • creates more dead space
  • not for dividing strong fascial attachments

Technique

• closed tips of the scissors are inserted into tissue
• blades are opened separating [tearing] loose tissue connections
• scissors tips are removed without closing the blades to prevent uncontrolled cutting
• the process is repeated as needed

Blunt dissection