Key Takeaways
- Surgical instruments are classified as cutting/dissecting (scalpels, scissors), grasping/clamping (forceps, hemostats), retracting (retractors), or probing/dilating
- Common surgical instruments include scalpels, suture scissors, tissue forceps, hemostats (Kelly, mosquito), and needle holders
- The sterile field must be maintained during minor surgery -- anything below waist level or out of sight is considered contaminated
- The medical assistant sets up the sterile field, passes instruments, and assists the physician during minor surgical procedures
- Wound closure methods include sutures, staples, Steri-Strips, and tissue adhesive (Dermabond)
- Suture removal timing varies by location: face 3-5 days, scalp 7-10 days, trunk/extremities 7-14 days
- Biopsy types include excisional (entire lesion removed), incisional (portion removed), punch (cylindrical core), and shave (superficial)
- Sterile supplies have expiration dates and must be checked before use -- do not use if packaging is damaged, wet, or expired
Last updated: February 2026
Surgical Instruments & Minor Surgery Assisting
Medical assistants frequently assist physicians with minor office surgical procedures such as laceration repair, lesion removal, biopsies, and incision and drainage (I&D). Understanding surgical instruments, sterile technique, and wound care is essential.
Surgical Instrument Classification
| Category | Purpose | Examples |
|---|---|---|
| Cutting/Dissecting | Cut tissue, sutures, or dressings | Scalpels (#10, #11, #15 blades), operating scissors, suture scissors, iris scissors |
| Grasping/Clamping | Hold tissue or clamp blood vessels | Tissue forceps (Adson, rat-tooth), hemostats (Kelly, mosquito), towel clamps |
| Retracting | Hold tissue or wound edges apart for visibility | Senn retractors, skin hooks, Army-Navy retractors |
| Probing/Dilating | Explore wounds or dilate openings | Probes, dilators, sounds |
| Suturing | Close wounds with stitches | Needle holders, suture material (absorbable and non-absorbable) |
Common Scalpel Blades
| Blade Number | Shape | Use |
|---|---|---|
| #10 | Curved, large | General incisions, larger cutting areas |
| #11 | Pointed, triangular | Stab incisions, I&D of abscesses, sharp dissection |
| #12 | Hooked/curved | Specialized procedures |
| #15 | Small curved | Precision work, small incisions, delicate procedures |
Common Hemostats
| Type | Size | Use |
|---|---|---|
| Mosquito hemostat | Small, delicate | Clamping small blood vessels |
| Kelly hemostat | Medium | General-purpose clamping; serrated jaws (half-length) |
| Crile hemostat | Medium | Similar to Kelly but fully serrated jaws |
| Rochester-Carmalt | Large | Large vessel or tissue clamping |
Suture Materials
| Type | Category | Absorption | Examples |
|---|---|---|---|
| Absorbable | Dissolves over time | 10-60+ days | Chromic gut, Vicryl (polyglactin), Monocryl, PDS |
| Non-absorbable | Must be removed | Does not absorb | Nylon (Ethilon), silk, polypropylene (Prolene) |
Suture Removal Timelines
| Body Area | Removal Time |
|---|---|
| Face | 3-5 days |
| Scalp | 7-10 days |
| Arms/legs | 7-10 days |
| Trunk/abdomen | 7-14 days |
| Joints (over moving areas) | 10-14 days |
| Feet/hands | 10-14 days |
Setting Up the Sterile Field
Rules for Maintaining Sterility
- Only sterile items touch the sterile field -- never place non-sterile items on the field
- A sterile field is considered contaminated if:
- Unsterile object touches the field
- The field becomes wet (moisture wicks bacteria through)
- The field is left unattended (even briefly)
- Items fall below waist level
- The outer 1-inch border of a sterile field is considered NON-sterile
- Reach over the sterile field only when necessary and avoid passing over it
- Keep the sterile field within your line of sight at all times
- Open sterile packages by opening the flap farthest from you first, then the sides, then the flap closest to you
- Pour solutions from at least 6 inches above the container to avoid splashing
Sterile Field Setup Procedure
- Verify the procedure and obtain informed consent (physician responsibility)
- Gather all supplies and check expiration dates/package integrity
- Perform hand hygiene
- Open the sterile pack on a clean, dry, flat surface
- Open flaps in correct order (far, sides, near -- do not cross over field)
- Add additional sterile items by dropping or using sterile transfer forceps
- Apply sterile gloves using aseptic technique
- Arrange instruments on the sterile field in order of use
Types of Biopsies
| Type | Technique | Use |
|---|---|---|
| Excisional | Entire lesion removed with margin of normal tissue | Small lesions, suspected malignancy |
| Incisional | Portion of lesion removed for analysis | Large lesions where complete removal is not practical |
| Punch | Cylindrical core of tissue removed with punch tool | Skin lesions, diameter typically 2-8 mm |
| Shave | Superficial layer shaved off with scalpel or razor | Raised skin lesions, moles |
| Needle/core | Tissue obtained with large-bore needle | Breast, prostate, liver, kidney |
| Fine needle aspiration (FNA) | Cells aspirated with thin needle and syringe | Thyroid nodules, breast lumps, lymph nodes |
Wound Care
Wound Classification
| Type | Description | Example |
|---|---|---|
| Clean | No infection, no GI/GU/respiratory tract entry | Elective surgery in sterile conditions |
| Clean-contaminated | Controlled entry to GI/GU/respiratory tract | Appendectomy without spillage |
| Contaminated | Open trauma, spillage from GI tract | Open fractures, accidental wounds |
| Dirty/infected | Old traumatic wounds, existing infection | Abscess drainage, perforated bowel |
Wound Healing Phases
| Phase | Timeframe | Process |
|---|---|---|
| Inflammatory | 0-3 days | Bleeding stops, white blood cells arrive, swelling and redness |
| Proliferative | 3-21 days | New tissue (granulation), blood vessel formation, wound contraction |
| Maturation (remodeling) | 21 days - 2 years | Collagen reorganization, scar formation, strength increases |
Test Your Knowledge
The #15 scalpel blade is best suited for:
A
B
C
D
Test Your Knowledge
When opening a sterile package, which flap should be opened FIRST?
A
B
C
D
Test Your Knowledge
Sutures on the face are typically removed after:
A
B
C
D
Test Your Knowledge
A biopsy that removes the entire lesion along with a margin of normal tissue is called a(n):
A
B
C
D
Test Your KnowledgeFill in the Blank
The outer ___-inch border of a sterile field is considered non-sterile (contaminated).
Type your answer below