Chapter 3: Table of contents
Scalpel Handling:
Scalpels are used to create incisions in tissues and can be held in a pencil, palm or fingertip grip. The pencil grip allows maximum control over the cut but reduces the contact surface between the blade and the tissues because of the angle created, making it ideal for short incisions. The palm and fingertip grips (aka dinner knife grip) result in better contact of the cutting edge of the blade against the tissues (horizontal position); this is advantageous when making long incisions.
Fingertip Grip:
The fingertip grip involves the entire scalpel handle being held with the fingertips (without contacting the palm of the hand). A modification involves placing the index finger on the upper surface of the handle, without obstructing the surgeon’s view. This grip creates better contact between the cutting edge of the blade and the tissues (horizontal position) compared to the pencil grip; this is advantageous when making long incisions.
Pencil Grip:
A pencil grip involves holding the scalpel handle between the thumb and index finger, as one would hold a pencil. The pencil grip allows maximum control over the cut but reduces the contact surface between the blade and the tissues because of the angle created, making it ideal for short incisions.
Palm Grip:
The palm grip involves holding the scalpel handle within the palm of the hand. The thumb can be placed on the upper surface of the handle to create more force and increase control. It is best suited for long incisions requiring greater pressure; due to the position of the blade on the skin, it results in better contact between the blade and the tissues compared to the pencil grip. This grip is rarely used to create incisions but can be used with other instruments such as periosteal elevators.
Stab Incision:
The tip of a scalpel blade can be used to create a stab incision into a cavity (abdomen) or a hollow viscus such as the stomach, intestine or urinary bladder. For this, the scalpel is typically held with a pencil grip position to allow maximum control of penetration depth.