View source for Scalpel

{{Short description|Sharp bladed instrument used for surgery}}
{{Other uses}}
{{More citations needed|date=January 2008}}
{{Infobox tool
| image          = Various scalpels.png
| image_upright  = yes
| caption        = Various scalpels. The first (from left), second, and fourth have replaceable blades. The fifth is a lancet.
| used_with      = [[Stencil]], [[surgery]]
| classification = [[Cutting tool]]
| related        = Lancet, [[utility knife]], [[laser scalpel]]
}}

A '''scalpel''' or '''bistoury''' is a small and extremely sharp bladed instrument used for [[surgery]], [[anatomical]] [[dissection]], [[podiatry]] and various [[handicraft]]s. A '''lancet''' is a double-edged scalpel.

Scalpel blades are usually made of hardened and [[tempered steel]], [[stainless steel]], or [[high carbon steel]]; in addition, [[titanium]], [[Ceramic knife|ceramic]], [[diamond]] and even [[obsidian]] knives are not uncommon. For example, when performing surgery under [[magnetic resonance imaging|MRI]] guidance, steel blades are unusable (the blades would be drawn to the magnets and would also cause image [[Artifact (medical imaging)|artifacts]]). Historically, the preferred material for surgical scalpels was [[silver]]. Scalpel blades are also offered by some manufacturers with a zirconium nitride–coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut.

Scalpels may be [[Disposable product|single-use]] disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a [[utility knife]]) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile.

Alternatives to scalpels in surgical applications include [[Cauterization#Electrocautery|electrocautery]] and [[laser]]s.

== History ==
[[file:Lancets belonging to Edward Jenner 2.jpeg|thumb|left|A lancet belonging to [[Edward Jenner]]]]

Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.<ref>{{cite web|url=https://www.newscientist.com/article/mg20727750-200-scalpels-and-skulls-point-to-bronze-age-brain-surgery/|title=Scalpels and skulls point to Bronze Age brain surgery|author=Jo Marchant|work=New Scientist}}</ref> Skulls from the same time and place show signs of brain surgery.<ref>{{cite web|url=http://www.hurriyetdailynews.com/default.aspx?pageid=438&n=0717104921378-2010-07-19|title=ARTS-CULTURE – Excavations restarting at İkiztepe in northern Turkey}}</ref>

[[Ancient Egyptian medicine|Ancient Egypt]]ians made incisions for embalming with scalpels of sharpened [[obsidian]], a material that is still in use.

The first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.<ref>{{cite journal|title=Surgical Knife | pmc=2763477 | pmid=19876423 | volume=36 | issue=5 |date=2009 | journal=Tex Heart Inst J | pages=441–3 | author=Ochsner J}}</ref> The ''amphismela'' was an anatomical knife-edged on both sides. The term comes from the [[Greek language|Greek]] ''αμφι'' (''amphi'', "on both sides"), and ''μελιζω'' (''inside'', "I cut").<ref name="1728 Amphismela">{{Cyclopaedia 1728|title=Amphismela}}</ref>

[[Medicine in ancient Rome|Ancient Romans]] used more than 150 different surgical instruments, including scalpels.<ref>{{cite news |url=https://www.telegraph.co.uk/news/worldnews/1572030/Roman-ruins-cast-new-light-on-a-trip-to-doctor.html |title=Roman ruins cast new light on a trip to doctor |newspaper=Telegraph.co.uk |date= December 9, 2007 }}</ref>

10th century Arab-Spanish surgeon [[Albucasis]] invented a retractable scalpel.<ref>{{Cite journal |last1=Ahmadi |first1=Seyedeh Aida |last2=Zargaran |first2=Arman |last3=Mehdizadeh |first3=Alireza |last4=Mortazavi |first4=Seyed Mohammad Javad |date=2013-04-21 |title=Remanufacturing and Evaluation of Al Zahrawi's Surgical instruments, Al Mokhdea as Scalpel Handle |url=https://www.gmj.ir/index.php/gmj/article/view/42 |journal=Galen Medical Journal |volume=2 |issue=1 |pages=22–25 |doi=10.31661/gmj.v2i1.42 |s2cid=245939350 |issn=2322-2379|doi-access=free }}</ref>

The French used an amphismela in the 1700s.<ref>{{Cite journal |last=Dunglison |first=Robley |url=http://archive.org/details/paper-doi-10_1097_00000441-184816320-00026 |title=Art. XXVI.—Medical Lexicon. A Dictionary of Medical Science, containing a concise explanation of the various subjects and terms, with the French and other Synonymes, notices of Climate and of celebrated Mineral Waters. Formaiœ for various officinal and empirical Preparations, etc. |journal=The American Journal of the Medical Sciences |date=October 1848 |publisher=Elsevier BV |volume=32 |pages=428–429 |doi=10.1097/00000441-184816320-00026 |issn=0002-9629 |issue=16}}</ref>

South African scientists showed that a blunt scalpel caused sharp cuts if the blade was subjected to ultrasound.<ref>{{cite journal | vauthors=Carlson CS, Pohl A, Keir D, Postema M | title=Cutting edge technology: sound sharpens the blade | journal=Applied Acoustics | date=2020 | volume=166 | article-number=107336 | doi=10.1016/j.apacoust.2020.107336 | s2cid=216197723 | url=https://hal.archives-ouvertes.fr/hal-03192706/document }}</ref> Applications might be in energy-saving paper cutting.<ref>{{cite conference |vauthors=Shava KL, Hlakudi C, Postema M, Carlson CS |title=Finetuning a single-blade sonic paper-cutter as an energy-saving sharpening instrument |conference=International Conference on Electrical, Computer and Energy Technologies |location=Cape Town, South Africa |date=December 2021 | pages=9698577 | doi=10.1109/ICECET52533.2021.9698577 | isbn=978-1-6654-4231-2 | s2cid=246751942 | url=https://hal.archives-ouvertes.fr/hal-03410525/document }}</ref>

== Operation ==
{{multiple image|
| image1   = ScalpelGrip Palmar-Plain.svg
| caption1 = Palmar grip
| image2   = ScalpelGrip Pencil-Plain.svg
| caption2 = Pencil grip
}}

In the ''palmar grip'', also called the "dinner knife" grip, the handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.

In the ''pencil grip'', best used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle, the scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb.

== Types ==

=== Surgical ===
{{multiple image
| image1            = scalpel handle 3.jpg
| caption1          = Reusable scalpel handles
| image2            = disposable scalpels-small and large.jpg
| caption2          = Disposable scalpels
}}

Surgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (sometimes just for a single, small cut).

The handle is also known as a "B.P.&nbsp;handle", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented the 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used.<ref name="THIJ Ochsner">{{cite journal|last=Ochsner|first=J|title=Surgical knife|journal=Texas Heart Institute Journal |date=2009|volume=36|issue=5|pages=441–443|pmid=19876423|pmc=2763477}}</ref>

The handle of medical scalpels come in several basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle is larger than a #3.  #5 handles are also common, and are round, with a patterning to ensure a non-slip grip. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle.  The following table of blades is incomplete and some blades listed may work with handles not specified here.

A lancet has a double-edged blade and a pointed end for making small incisions or drainage punctures.

=== Handicraft ===
[[file:X-Acto-knife.jpg|thumb|[[X-Acto knife]]]]

[[Graphic design|Graphical]] and model-making scalpels tend to have round handles, with textured grips (either [[Knurling|knurled]] metal or soft plastic). The blade is usually flat and straight, allowing it to be run easily against a [[straightedge]] to produce straight cuts.

There are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for [[wood carving]], cutting leather and heavy fabric.

== Blades ==
[[File:Bisturi Tacca Millimetrata.jpg|thumb|Graduated handle]]
[[File:Scalpel handle 3.jpg|thumb|3 and 3 long handles]]
[[File:Scalpel blade sizes.JPG|thumb|none|upright=1.7|Some of the scalpel blade types used for surgery]]

{| class="wikitable"
|+ Types of surgical scalpel blades
|-
! Blade no. !! Picture !! Compatible handles !! Blade description !! Uses
|-
|  6 || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  9 || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  10 |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || Curved cutting edge with an unsharpened back edge. A more traditional blade shape. || Generally for making incisions in skin and muscle. Commonly used to cut the skin in [[General surgery|abdominal operations]].
|-
|  10a ||[[File:Scalpel blade 10A.jpg|120px]]|| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || This blade is a small and straight ||
|-
|  11 ||[[File:Scalpel11.jpg|120px]]|| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || Triangular blade with sharp point, flat cutting edge parallel to the handle and flat back || For precision cutting, stripping, sharp angle cuts and also [[stencil]] cutting due to its similarity to the X-Acto artknife blade
|-
|  11P || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  E11 || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  E/11 || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || || Debriding hard skin for example [[callus]] by Podiatrists. 
|-
|  12 ||[[File:Scalpel12.jpg|120px]]|| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || A small, pointed, crescent-shaped blade sharpened on the inside edge of the curve ||
|-
|  12D |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || A small, pointed, crescent-shaped blade sharpened on both sides of the curve ||
|-
|  13 || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  14 || || B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  15 ||[[File:Surgical Blade.jpg|120px]]|| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || A smaller version of the #10 || For the same general use as the #10 blade
|-
|  15A |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || A front-facing straight blade with flat back ||
|-
|  15C |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || The #15 with a downward angle, flatter and thinner than the #15 || The downward angle makes this the preferred blade for working within the chest during cardiac surgery, and is commonly used to make the distal arteriotomy during coronary artery bypass grafting.
|-
|  15T |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || || Enucleation of lesions such as [[corn (medicine)|corn]]s.
|-
|  D/15 |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  16 |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || A narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handle || For cutting stencils, scoring and etching
|-
|  17 |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || A flat face 1.6&nbsp;mm chisel blade || For narrow cuts
|-
|  18 |||| 4, 4 Graduated, 4 Long, 6 || A 12.7&nbsp;mm chisel blade || For deep cuts and scraping
|-
|  19 |||| 4, 4 Graduated, 4 Long, 6 || A similar blade to the #15  ||
|-
|  20 ||[[File:Scalpel20.jpg|120px]]|| 4, 4 Graduated, 4 Long, 6 || A larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back edge. || Used in general surgery and orthopaedic surgery.
|-
|  21 ||[[File:Scalpel21.jpg|120px]]|| 4, 4 Graduated, 4 Long, 6 || ||
|-
|  22 |||| 2, 4, 5, 6 || A slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back edge. || Used for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery.
|-
|  22A || || 4, 4 Graduated, 4 Long, 6 || ||
|-
|  23 ||[[File:Scalpel23.jpg|120px]]|| 4, 4 Graduated, 4 Long, 6 || Similar to #22, leaf-shaped || For long incisions.
|-
|  24 |||| 4, 4 Graduated, 4 Long, 6 || A wide, flat, angled cutting edge  || For corner cuts, trimming, stripping, and [[cutting mat]]s and gaskets
|-
|  25 |||| 4, 4 Graduated, 4 Long, 6 || A front-facing straight blade with flat back (similar to #15a) ||
|-
|  25a |||| 4, 4 Graduated, 4 Long, 6 || A triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26) ||
|-
|  26 ||[[File:Scalpel26.jpg|120px]]|| 4, 4 Graduated, 4 Long, 6 || A triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a) ||
|-
|  27 |||| 4, 4 Graduated, 4 Long, 6 || ||
|-
|  34 |||| 4, 4 Graduated, 4 Long, 6 || A triangular blade similar to the #11 ||
|-
|  36 |||| 4, 4 Graduated, 4 Long, 6 || A larger blade ||Used in general surgery but also within a laboratory setting for histology and histopathology
|-
|  40 |||| B3, 3, 3 Graduated, 3 Long, 5, 7, 9 || ||
|-
|  PM40 |||| Stainless PM Handle || ||
|-
|  PM40B |||| Stainless PM Handle || ||
|-
|  60 |||| 4, 4 Graduated, 4 Long, 6 || A long blade resembling the #10 with a long cutting edge, rounded tip and flat back. ||
|-
|  PM60 |||| PM8 || ||
|-
|  PM60B |||| PM8 || ||
|}

== Safety ==
{{See also|Needlestick injury}}
{{Globalize|section|US|date=January 2021}}

Rising awareness of the dangers of [[Hypodermic needle|sharps]] in a medical environment around the beginning of the 21st century led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the [[Centers for Disease Control and Prevention]], as many as 1,000 people were subject to accidental needle sticks and lacerations each day in the United States while providing medical care. Additionally, surgeons can expect to suffer hundreds of such injuries over the course of their career.<ref>{{cite book |last1=Schoub |first1=B. D. |title=AIDS and HIV in Perspective: A Guide to Understanding the Virus and Its Consequences |date=10 June 1999 |publisher=Cambridge University Press |isbn=978-0-521-62766-5 |page=114 |url=https://books.google.com/books?id=6LPyq4YfCKYC&pg=PA114 |language=en}}</ref> Scalpel blade injuries were among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries made up 7 percent to 8 percent of all sharps injuries in 2001.<ref name="Perry2003">{{cite journal |vauthors=Perry J, Parker G, Jagger J |date= 2003 | title = EPINet Report: 2001 Percutaneous Injury Rates | journal = Advances in Exposure Prevention | volume = 6 | issue = 3| pages = 32–36 }}</ref><ref name="CDC">{{cite web |publisher=Cdc.gov (Centre for Disease Control and Prevention) |title=Sharps Injury Prevention Workbook |url= https://www.cdc.gov/SharpsSafety/workbook.html }}</ref>

"Scalpel Safety" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.<ref name="Sinnott2007">{{cite journal |author1=Sinnott M. |author2=Wall D. |date= 2007 | title = 'Scalpel Safety': How safe (or dangerous) are safety scalpels? | journal = International Journal of Surgery | volume = 6 | issue = 2| pages = 176–177 | doi = 10.1016/j.ijsu.2007.01.010 |pmid=18442809 | doi-access = free }}</ref>

Safety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act, which requires hospitals to minimize the risk of pathogen transmission through needle or scalpel-related accidents.<ref>{{cite book |last1=Arindam |first1=Bit |title=Design and Development of Affordable Healthcare Technologies |date=22 June 2018 |publisher=IGI Global |isbn=978-1-5225-4970-3 |page=29 |url=https://books.google.com/books?id=yvZcDwAAQBAJ&pg=PA29 |language=en}}</ref>

There are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, [[DeRoyal]], Jai Surgicals, [[Swann-Morton]], and [[PenBlade]] are more intuitive to use due to their similarities to a standard box-cutter.  Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as [[Aditya Dispomed]], [[Aspen Surgical]] and [[Southmedic]]. A few companies {{who|date=December 2016}} have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.

There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.<ref name="Fuentes2008">Fuentes, H., et al. (2008). "Scalpel Safety": Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries." The International Journal of Risk & Safety in Medicine 20(1–2):83–89.</ref> There are companies which offer a single-handed scalpel blade remover that complies with regulatory requirements such as US [[Occupational Safety and Health Administration]] Standards.<ref name="OSHA2005">{{cite web |title=OSHA Standard Interpretations – Use of passing trays and single-handed scalpel blade remover in a surgical setting |url= https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25339 |publisher=[[Occupational Safety and Health Administration]] |date= December 22, 2005 }}</ref>

The usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.<ref name="Fuentes2008" /> It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.

== See also ==

* {{annotated link|Laser scalpel}}

== References ==
{{refs}}

==External links==
{{commonscat|Scalpels}}

* [https://dx.doi.org/10.1016/j.apacoust.2020.107336 Sonic scalpel]

{{Cutting and abrasive tools}}
{{Knives}}
{{Surgical instruments}}

[[Category:Medical knives]]
[[Category:Surgical instruments]]