Paring

Fig. 14.1

Improperly using a #11 blade (which is straight) for paring. Unintended contact of proximal and distal ends of the blade to normal skin occurs

Solution

Use a #15 blade (Fig. 14.2). #15 blades are convex and small enough to control comfortably. Note traction of the thumb behind the blade and opposite to blade motion.

Fig. 14.2

Convex edge of the #15 blade contacts target without injuring surrounding normal skin

Accidents Happen When

A large blade is used to pare a small lesion (Fig. 14.3). Larger convex blades can cause unintended injury to lesion margins.

Fig. 14.3

#10 blades and #22 blades are often too broad to pare smaller lesions

Solution

Use a #15 blade.

Accidents Happen When

Paring is performed without traction. Bunching of tissue, slippage, and uncontrolled blade movement can result in a laceration to physician or patient (Fig. 14.4).

Fig. 14.4

No traction can result in laceration from blade slippage

Solution

Place traction behind the blade with the thumb (Fig. 14.2).

Accidents Happen When

Paring is attempted without a blade handle (Fig. 14.5). Nerve injury to the finger pad can result when paring densely hyperkeratotic lesions with high resistance.

Fig. 14.5

Finger pad injury with prolonged, repeated, high pressure from the blade when not using a blade handle. (a) High pressure. (b) Resultant indentation associated with dysesthesia

Solution 1

The blade can safely be used off the handle for smaller, softer lesions.

Solution 2

Hold the blade handle like a pencil (Fig. 14.6).

Fig. 14.6

Holding the scalpel like a pencil yields fine control but may strain the index finger and thumb, which bear the brunt of skin resistance

Solution 3

Use a blade handle wedged against the index finger and fourth web space. Fingers are fixed during paring, which occurs with wrist flexion (Fig. 14.7).