#Surgical blade sizes skin
If, however, the skin lesion is of viral origin such intervention is doomed to failure whilst at the same time exposing the patient to risk of transfer metatarsalgia and stiff floating toes ( Finney et al 2003, Gibbard & Kilmartin 1998, Helal 1975, Kitaoka & Patzer 1998).įailure of lesser metatarsal surgery is not uncommon. The inaccuracy of clinical diagnosis is alarming because plantar corns have often been treated surgically by metatarsal osteotomy with the intention of reducing forces on the skin in the area of the lesion. In the absence of the specialised equipment required for electrosurgery, full-thickness lesion excision under local anaesthetic should be considered as a partially effective treatment option that sufferers should be made aware of.įifty-one per cent of the excised skin lesions were misdiagnosed as plantar corns when in fact they were verrucae.
In the present study, full-thickness skin excision has been found to be more effective than scalpel debridement but similar in effect to electrosurgery, with complete resolution of the plantar lesion occurring in 20 (46.5%) of the 43 patients. Bevans & Bosson (2010) compared electrosurgery with debridement and found a statistically significant reduction in pain at 6 months with a complete resolution in 26% and partial resolution in a further 50%, compared with complete resolution in 4% and partial resolution in 28% following scalpel debridement only. With scalpel debridement providing only limited relief when reviewed in controlled circumstances, could surgical intervention be more effective? In a study of 30 patients undergoing electrosurgery, Anderson & Burrow (2002) reported complete resolution in 52% of cases and a further 34% remained asymptomatic, although callus still developed in the area of electrosurgery treatment.
#Surgical blade sizes trial
Similarly, a randomised trial on the effectiveness of scalpel debridement for painful calluses in older people indicated little benefit when compared with sham scalpel debridement ( Landorf et al 2013). When compared with sham scalpel debridement in rheumatoid patients it was found that debridement reduced forefoot pain, but the effect was as short lived as the sham treatment ( Davys et al 2005). Scalpel debridement for plantar keratosis has been demonstrated to reduce forefoot pain in patients with rheumatoid arthritis ( Redmond et al 1999) though the relief tends to be limited to just seven days ( Balanowski & Flynn 2005, Woodburn et al 2000). Timothy Kilmartin, in Neale's Disorders of the Foot and Ankle (Ninth Edition), 2020 Discussion In either case, the scalpel handle must be autoclaved after each use. Inevitably, the lifespan of any autoclaved scalpel blade is limited, and only stainless steel blades can be adequately recycled.
After use on a patient, blades should be either discarded or sterilized. The rounded end of the instrument is used for enucleation ( Figs 6.1D and 6.2 (blade 15)). In general, a large blade should be used on very thick plantar callus, and a smaller blade should be used on small lesions and lesions on the dorsum or apex of the toes.įor enucleation, a blade with a rounded end should be chosen, such as a size 15 blade. Both the 10 and the 11 blades are primarily used for debridement. Both the point and the straight edge are valuable in different situations.
The 10 blade is a long, curved blade, while the 11 is a straight blade with a sharp point. Interestingly, American podiatrists use chisels, while in the UK, size 10, 11 and 15 blades are favoured. In these instances, the sterile disposable blade is dispensed onto the BP scalpel with the appropriate instrument, and removed with safety devices to prevent unnecessary laceration of the practitioner's fingers ( Ch. Interlocking blades fitted to Baird–Parker (BP) handles ( Figs 6.1C and 6.2), for example, have been known to snap when used on dense callosity. Blades from the mini-blade system are screwed to a handle of the appropriate design to achieve a sufficient degree of stiffness some scalpel handles are less suitable as they are more flexible.
Microblades are also available but they have less application in cutaneous debridement. In Figure 6.1D, only the 67 blade is shown others do exist, such as blades 61–66, 68 and 69, which have chisel-shaped, pointed or hooked ends. The advantage of the Beaver scalpel arises from the ability to fit different styles of ‘mini-blade’ onto one handle. 6.1D) is the one that most closely resembles the traditional solid scalpel, which was used prior to the advent of replaceable blades ( Fig. There is a wide variety of differently sized and shaped scalpels and scalpel blades on the market. A nail drill fitted with an abrasive disc can also be used to debride thickened skin. The scalpel is the most popular and common tool for debridement and enucleation. Merriman, in Clinical Skills in Treating the Foot (Second Edition), 2005 Equipment
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