3.3 Surgical Instruments & Minor Surgery Assisting
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
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
- Do not reach over the sterile field -- even in sterile gloves, your arms and sleeves are not sterile
- 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 |
The #15 scalpel blade is best suited for:
Large surgical incisions
Stab incisions and I&D procedures
Precision work and small, delicate incisions
Amputation procedures
When opening a sterile package, which flap should be opened FIRST?
The flap closest to you
The flap farthest from you
The right side flap
Any flap -- order does not matter
Sutures on the face are typically removed after:
1-2 days
3-5 days
7-10 days
14-21 days
A biopsy that removes the entire lesion along with a margin of normal tissue is called a(n):
Incisional biopsy
Excisional biopsy
Punch biopsy
Shave biopsy
The outer ___-inch border of a sterile field is considered non-sterile (contaminated).
Type your answer below
Sections you finish are checked off in the contents.