Introduction
Building your first surgical instrument set requires navigating hundreds of catalog options, each with specific design features and applications. A study tracking instrument performance found that surgical scissors may require repair after as few as 40 procedures, making proper selection critical from the start.
For new surgeons, residents, and surgical teams, the challenge lies in distinguishing essential instruments from specialized ones. Which 10-15 tools provide the foundation for most skin surgery procedures? Which serve narrow, procedure-specific functions?
This guide covers the core instrument categories—scissors, forceps, scalpels, and closure devices—with selection criteria and a practical starter set checklist for skin surgery procedures.
TLDR: Key Takeaways About Essential Skin Surgery Instruments
- Three essential scissors—Mayo, Metzenbaum, and Iris—handle different tissue types and cutting depths
- Forceps come in two types: toothed (1×2 or 2×3 teeth) for secure tissue grip and smooth-tipped for gentle handling
- Blade numbers (#10, #11, #15) match specific incision types and surgical field sizes
- A starter set requires 8-12 essential instruments covering cutting, grasping, clamping, and closure functions
- Bioabsorbable closure systems offer faster closures than manual suturing while eliminating staple removal
Understanding Surgical Instrument Categories
Surgical instruments are organized into five primary functional categories:
The Five Core Categories:
- Cutting instruments - Scissors, scalpels, and specialized blades for tissue division
- Grasping/holding instruments - Forceps and clamps for tissue manipulation
- Clamping instruments - Hemostats for bleeding control
- Retracting instruments - Devices that hold tissue aside for exposure
- Closure instruments - Needle holders and suturing tools
Design Follows Function
Instrument design reflects its intended use. Serrations provide grip without crushing tissue, teeth allow secure handling of dense structures, and curves enable access to deeper surgical fields.
A curved Mayo scissor's semi-blunt tip protects underlying tissues during fascial dissection, while an Iris scissor's sharp point enables precise dermal undermining.
Understanding these design principles helps you select the right tool for each task. Surgical catalogs list hundreds of specialized instruments, but mastering 10-15 essential tools provides the foundation for most skin surgery procedures.
These core instruments handle 80-90% of routine tasks, with specialized tools added only when procedures demand them.
Surgical Scissors: Types and Applications
Three scissor types dominate skin surgery: Mayo, Metzenbaum, and Iris. Each serves distinct functions based on tissue density and precision requirements.
Mayo Scissors
Mayo scissors are heavy-duty cutting instruments with semi-blunt tips, characterized by an approximately 1:1 handle-to-blade ratio. The American College of Surgeons identifies Mayo scissors as essential instruments that residents must master during PGY-1 training.
Two design variations serve different purposes:
- Straight Mayo - Used specifically for cutting suture material
- Curved Mayo - Designed for coarse dissection of heavy tissues including fascia, ligaments, and thick capsular structures
Their robust construction makes them unsuitable for delicate work but ideal for cutting through dense tissue layers.
Metzenbaum Scissors
While Mayo scissors handle heavy-duty work, Metzenbaum scissors (commonly called "Metz") excel at finer tasks. They feature longer handles and shorter, finer blades compared to Mayo scissors, with a long handle-to-blade ratio that provides extended reach.
Their blunt tips protect delicate structures during dissection, making them optimal for blunt dissection of soft tissues like subcutaneous layers. Never use Metzenbaum scissors to cut sutures, drains, or heavy fascia—this dulls the delicate blades and compromises their precision cutting ability.
Iris Scissors
Originally designed for ophthalmic procedures, Iris scissors have become standard instruments for dermatologic and plastic surgery.
Beyond the three primary types, additional scissors serve specialized applications:
- Tenotomy scissors - Extremely fine instruments for delicate tendon work
- Littauer suture scissors - Designed specifically for suture removal with a hooked tip
For general skin surgery, the three primary types (Mayo, Metzenbaum, Iris) handle virtually all cutting needs. Invest in specialized scissors only when your procedure volume justifies dedicated instruments for specific tasks.
Surgical Forceps: Grasping and Holding Instruments
Surgical forceps serve as the surgeon's primary grasping and holding tools during procedures. These instruments are categorized by the presence and configuration of teeth, which directly determine their tissue-handling capabilities and appropriate applications.
Tissue Forceps (Toothed)
Tissue forceps feature small teeth or serrations at the tips that interlock to provide secure grip on tissues.
Common varieties include:
- Adson tissue forceps - Available in 1×2 or 2×3 tooth configurations
- Standard tissue forceps - Broader tips for larger tissue handling
Tooth notation explained: The numbers indicate tooth count on each jaw. A 1×2 configuration means one tooth on one side interlocking with two teeth on the other, providing secure grip without excessive tissue trauma.
Appropriate use cases:
- Grasping skin edges during closure
- Handling fascia and dense connective tissue
- Manipulating tough tissue structures
Dressing Forceps (Non-Toothed)
Dressing forceps have smooth or serrated tips without teeth, designed for handling delicate tissues and materials without causing trauma.
Primary applications include:
- Handling surgical dressings and drapes
- Manipulating delicate structures like blood vessels
- Providing traction during fine dissection
Guiding principle: Use toothed forceps for tough tissues that require secure grip; use non-toothed forceps for delicate structures where tissue preservation is critical.
Needle Holders
Beyond standard grasping forceps, needle holders represent a specialized category designed specifically for suturing. These instruments feature a locking mechanism that securely grips surgical needles during tissue closure.
Key features:
- Carbide or diamond-coated jaws prevent needle rotation
- Ratchet mechanism provides controlled tension
- Tungsten carbide inserts are identified by gold-plated rings and offer superior durability
Critical selection factor: Needle holders must be matched to specific needle sizes. Mismatching can damage both the instrument and the needle.
For certain procedures, surgeons may choose alternatives to traditional suturing, such as bioabsorbable subcuticular closure systems, which can reduce closure time while maintaining cosmetic outcomes.
Hemostatic Forceps (Clamps)
Hemostatic forceps like Kelly and Crile clamps control bleeding by clamping blood vessels.
Design variations:
- Curved clamps - Navigate around structures and reach deeper tissues
- Straight clamps - Provide direct access in superficial fields
Both types feature ratchet mechanisms that maintain constant pressure without hand fatigue.
Scalpels and Cutting Instruments
The scalpel remains the gold standard for initial incisions, consisting of two components: a reusable handle and a disposable blade.
Scalpel Anatomy and Blade Selection
Handle types:
- #3 handle - Fits smaller blades (#10, #11, #15)
- #4 handle - Fits larger blades for extensive incisions
Common Blade Sizes and Applications
| Blade # | Description | Primary Application |
|---|---|---|
| #10 | Curved cutting edge | Large skin incisions (laparotomy) and muscle incisions |
| #11 | Triangular, pointed tip | Stab incisions for abscess drainage; precise, sharply angled cuts |
| #15 | Small, curved edge | Most frequently used blade in dermatosurgery for precise skin incisions |
Safety Considerations
Proper scalpel handling protects surgical teams from sharps injuries, which remain a significant risk in operating rooms. The Association of Surgical Technologists (AST) and AORN recommend implementing neutral zone passing techniques.
Safety protocols:
- Use hands-free technique (HFT) to prevent two individuals from simultaneously handling sharps
- Employ single-handed blade removers when safety scalpels aren't available
- Dispose of sharps in puncture-resistant, leak-proof containers labeled with biohazard symbols
- Never pass scalpels hand-to-hand
Additional Essential Instruments for Skin Surgery
Retractors
Retractors provide surgical exposure by holding back tissue edges.
Hand-held retractors for skin surgery:
- Senn retractors - Small, double-ended retractors ideal for superficial work
- Army-Navy retractors - Slightly larger with curved blades for moderate depth
Surgeons reserve self-retaining retractors (Weitlaner, Gelpi) for larger procedures requiring continuous retraction without assistant fatigue.
Suture Materials and Needles
Choosing the right suture material and needle type ensures optimal wound healing and cosmetic outcomes.
Suture selection:
- Absorbable sutures (Vicryl, Monocryl) - For deep tissue layers and subcutaneous closure
- Non-absorbable sutures (Nylon, Prolene) - For skin closure requiring later removal or permanent support
Modern bioabsorbable closure systems like SubQ It! offer an alternative approach, combining the speed of stapling with subcutaneous placement that eliminates the need for removal while minimizing scarring.
Needle types:
- Cutting needles - Triangular cross-section for tough tissue like skin
- Reverse cutting needles - Cutting edge on outer curve, reducing tissue tear-through
- Tapered needles - Round cross-section for delicate tissue like fascia or bowel
Instrument Trays and Organization
Organization principles for standardized instrument trays:
- Group instruments by function (cutting, grasping, clamping)
- Arrange in sequence of use during procedures
- Place sharps in designated zones to prevent injury
- Use color-coding or labeling for quick identification
Building Your Starter Surgical Instrument Set: A Checklist
Essential Cutting Instruments
Scissors:
- One curved Mayo scissors (heavy tissue and suture cutting)
- One Metzenbaum scissors (delicate dissection)
- One Iris scissors (fine dermal work)
Scalpel handle and blades:
- One #3 handle
- Assorted blades: #10, #11, #15
Essential Grasping Instruments
Forceps and needle holders:
- Two Adson tissue forceps with 1×2 teeth (skin edge handling)
- Two Adson dressing forceps, non-toothed (delicate tissue manipulation)
- One needle holder, 5-6 inch length with carbide inserts
For high-volume facilities, bioabsorbable closure systems like SubQ It! can deploy 7× faster than manual sutures while eliminating staple removal appointments. These systems work alongside traditional instrument sets for specific procedures.
Essential Clamping and Hemostatic Instruments
Clamps:
- Two curved Kelly or Crile clamps (vessel control and tissue grasping)
- Two straight mosquito clamps (fine hemostasis in superficial fields)
Essential Retractors and Accessories
Retractors:
- Two Senn retractors (small field exposure)
- Two Army-Navy retractors (moderate depth exposure)
Additional accessories:
- Two towel clamps (drape securing)
- Basic needle counter (safety compliance)
Quality and Procurement Considerations
Material standards: Select surgical-grade stainless steel instruments meeting ISO 7153-1 specifications.
German or Japanese manufacturing standards indicate superior material quality and precision engineering.
Quality versus cost: Well-made instruments last decades with proper care.
Reusable instruments have an estimated lifespan of 300-900 sterilization cycles, making initial investment in quality more cost-effective than frequent replacement of inferior tools.
Approximate cost ranges:
- Basic starter set (8-12 instruments): $800-$1,500
- Individual premium instruments: $50-$200 each
- Sterilization costs per cycle: $0.59-$11.52 per instrument
Tungsten carbide instruments (identified by gold-plated rings) cost more but offer significantly extended wear resistance, particularly for needle holders and scissors.
Frequently Asked Questions
What's the difference between Mayo scissors and Metzenbaum scissors?
Mayo scissors are heavy-duty instruments with semi-blunt tips for cutting tough tissues like fascia and sutures. Metzenbaum scissors feature longer handles and finer blades for precise soft tissue dissection.
How often should surgical instruments be replaced?
High-quality instruments last 10-20 years with proper maintenance, typically 300-900 sterilization cycles. Replace them when showing pitting, corrosion, loss of cutting edge, or jaw misalignment.
What does "Adson 1×2" mean on forceps?
The numbers refer to the tooth configuration on the forceps tips. "1×2" means one tooth on one jaw interlocks with two teeth on the opposing jaw, providing secure tissue grip while minimizing trauma. This configuration is standard for general skin edge handling during closure.
Can I use the same instruments for all types of surgery?
Basic instruments like Mayo scissors and Adson forceps work across many procedures, but specialized surgeries require field-specific tools. Ophthalmic, neurosurgical, and orthopedic procedures demand specialized instruments that general tools cannot safely replace.
How should surgical instruments be cleaned and sterilized?
Keep instruments moist immediately after use with water or enzymatic spray (never saline). Clean with neutral pH detergents, inspect for damage, and autoclave per manufacturer Instructions for Use (IFU) and institutional protocols.
What's the most important factor when buying surgical instruments?
Quality over cost is paramount. Surgical-grade stainless steel from reputable manufacturers ensures longevity, reliability, and patient safety. Inferior instruments fail prematurely, compromise surgical precision, and ultimately cost more through frequent replacement and potential complications.
