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There is very little haemostasis with cutting diathermy and it really is just like using a scalpel. You will see some surgeons who never use cutting diathermy. The coagulation mode is commonly used to separate tissues. There is less bleeding than with the cutting setting, but more collateral heat injury. The degree of heat generated, and thus tissue destruction, is inversely proportional to the surface area of the diathermy blade in contact with the tissue—and so a light touch with the tip of the diathermy works better than pressure over a broad area.
The knife should be held at an angle of 20–30° to the horizontal and drawn firmly along, using the full length of the cutting edge. The movement occurs through the shoulder and elbow, and should be smooth, firm enough for the knife blade to penetrate the dermis and done at a regular, even speed. A good way to practise is with a pencil, drawing a long straight line on a sheet of paper. Firm and symmetrical traction should be applied with the surgeon’s opposite finger and thumb, keeping the skin edges apart and the depths of the wound in view (Fig.
It is also useful to designate one thread the ‘passive’ thread (the one you just hold in your hand) and the other the ‘active’ thread (the one that does all the work). In Fig. 1, the active thread is held in the surgeon’s LEFT hand. (a) (b) Fig. 1 (a) The index finger throw and (b) the middle finger throw. Instrument or hand tie? The choice is frequently one of personal preference. Tying with instruments uses less suture material and also allows more accurate knot construction when using fine sutures.