SHARP INSTRUMENTS 5

BONE-CUTTING INSTRUMENTS

Various bone-cutting instruments commonly seen in modern surgery are as follows:
Saw. Bone cutting forceps
Chisel. Rongeurs
Osteotome. Rougine
Bone gouge. Costotomes (Rib cutters)

Saws

All amputations of the extremities involve cutting through the central bone of the limb, thus the need for a saws.
These instruments have teeth on their cutting edge so as to facilitate cutting through bone.
Ferguson Saw has a broad blade and is used for big central bones of lower limb

Adams-Jones is a saw with a short narrow cutting blade and a blunt tip.
• Tip handle is designed to give a grip for the surgeon (Often called a pistol-grip handle) and a blade that can cut in a small space (neck of shaft femur).
• Powered bone saws allow bones to be cut in a short time with minimum effort. ( Stryker saw)
• Gigli saw is a cutting wire edge that cuts small spaces.
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SHARP INSTRUMENTS 4

SKIN GRAFTING KNIVES


Skin grafting knives are used for obtaining the superficial layers of skin (split thickness) for grafting.
They are therefore broad and lighter than amputation knives.
Those in use are

· Blair
· Humby
· Braithwaite
· Padgett’s dermatome

Skin-grafting knives are broad, but are lighter than conventional knives, they are used for obtaining large pieces of skin (split-thickness superficial) for grafting.
Some knives have guards, to prevent knife from going deep into skin.

Padgett’s dermatomes drum has adhesive on its surface, & adherent skin is cut on the drum, cut skin is then taken of the drum

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SHARP INSTRUMENTS 3

KNIVES

Amputation knives in use are:
· Liston’s
· Syme’s

Amputation knives are large, long, and heavy knives
They are used for surgical amputations thus have to go round the entire limb.
The bulk of the tissue such as muscles, vessels, and nerves, makes it necessary that these knives are large in size.
These knifes are of use limited to amputations
They are not included in any other sets

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SHARP INSTRUMENTS 2

BISTOURIES

Bistouries have a blunt end, followed by cutting edge.
These are long-bladed knives with a blunt end, and a curve on cutting edge.

HERNIA BISTOURY

Hernia bistoury is used to cut the constricting band that causes the strangulation in a hernia.
Bistouries are generally used to open hollow cavities or constricting band in a case of strangulated hernia.

TECHNIQUE

The blunt tip allows safe entry between the constricting band and the compressed intestine.
The instrument is then rotated, which brings be cutting edge against the strangulating band.
The strangulation can be released by cutting the band with the sharp edge away from the intestine (so as to avoid damage to the intestine).

FISTULA BISTOURY

Fistula bistoury can be introduced into the depth of the fistula.
It is rotated till the sharp edge is towards the skin.
The sharp edge lays vistopen the entire tract of fistula by cutting from inside.

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SHARP INSTRUMENTS !

SHARP CUTTING INSTRUMENTS
SCALPEL
A scalpel is a small knife used in surgical operations for incising the skin.
In surgical practice, the term, knife refers to a cutting tool other than a scalpel and is usually
reserved for amputation knives and skin grafting knives which are
substantially larger than scalpels.
A scalpel has two parts : (i) the handle, and (ii) the blade
joined together.
● Scalpel handle
● Scalpel blades numbers 10-25 . Disposable blades are also
available.
Scalpels are used for incising skin and deeper structures to obtain
access.
They are very sharp and thus cause minimum injury to incised tissue.
Scalpels in common use have separate handle and blade. Fixed handle and
blade scalpels require periodical sterilization and therefore sharpness of the
blades get damaged. Separate blades are sterile when packed requiring no
autoclaving; thus there is no loss of sharpness. Handles can be antoclaved
separately.
What are the criteria of an ideal scalpel?
● It should be light (handle not heavy) and have balanced body.
● Pressure of index finger should be able to control depth of the cut.
● The blade should be sharp to cut skin with ease without applying
pressure

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