INSTRUMENTS FOR INCISING TISSUE
Most surgical procedures begin with an incision. The instrument for making an incision is the scalpel, which is composed of a handle and a disposable, sterile sharp blade. The most commonly used handle is the no. 3 handle, but occasionally the longer, more slender no. 7 handle will be used (Fig. 6-1), The tip of the scalpel handle is prepared to receive a variety of differently shaped scalpel blades that can be inserted onto a slotted receiver
The most commonly used scalpel blade for intraoral surgery is the no. 15 blade (fig. 6-2). It is relatively small and can be used to make incisions around teeth and through mucoperiosteum. It is similar in shape to the larger no. 10 blade, which is used for large skin incisions. Other commonly used blades for intraoral surgery are the no. 11 blade and the no. 2 blade. The no. 11 blade is a sharp-pointed blade that is used primarily for making small stab incisions, such as for incising an abscess. The hooked no. 1.2 blade is useful for mucogingival procedures in which incisions must be made on the posterior aspect of teeth or in the maxillary tuberosity area.
The scalpel blade is carefully loaded onto the handle with a needle holder to avoid lacerating the operator’s fingers. The blade is held on the superior edge, where it is reinforced with a small rib, and the handle is held so that the male portion of the fitting is pointing upward (Fig. 6-3, rl). The knife -blade is then slid onto the handle until it clicks into position (Fig. 6-3, B). The knife is unloaded in a similar fashion. The needle holder grasps the most proximal
end of the blade (Fig. 6-3, C) and lifts it to disengage it from the male fitting. It is then slid off the knife handle in the opposite direction (Fig. 6-3, D). The used blade is discarded into a proper ‘rigid-sided “sharps” container.
When using the scalpel to make an incision, the surgeon holds it in the pen grasp (Fig. 6-4) to allow maximal control of tile blade as the incision is made. Mobile tissue should be held firmly to stabilize it so that as the incision is made, the blade will incise, not displace, the mucosa. When a mucoperiosteal incision is made, the knife should be pressed down firmly so that the incision penetrates the mucosa and periosteum with the same stroke. Scalpel blade are designed for single-patient use they are dulled verv easilv , when thev come into contact with hard tissue such as bone and teeth, If several Incisions through mucoperteum to bone are required, It may be necessary to use a second blade during a single operation. It is important to remember that dull blades do not make clean,sharp incision of tissue and therefore should be replaced when they become dull.