The cutting technique employed in the autopsy is, as a rule, quite
different from that employed in surgical operations or in dissection.
For the large incisions the cartilage-knife is used. It should be
held in the palm of the hand so that when the arm is extended the
knife-blade becomes an extension of the axis of the arm, and used
with a free arm-movement, fingers and hand being firmly fixed to
the knife-handle. Long, sweeping cuts, adequate in pressure, and
giving smooth and even incisions, are made by moving chiefly from the
shoulder, with secondary movement from the elbow. The knife-blade
should not be pressed or pushed into the tissues, but should be drawn
through them rather quickly, cutting as it is drawn. The greater
the force used, the more swift the drawing-motion should be. All
cuts should be clean; if made in the wrong place they will do less
damage than ragged, uneven incisions. The toe of the cartilage knife
is used for the beginning and end of long incisions and for cutting
in hollow or depressed surfaces. For flat surfaces the belly of the
knife is employed. The heel of the blade can be used for cutting
cartilages. The incisions made in the body should be directed away
from the operator, especial care being taken to avoid injuring his
left hand or the hands or arms of anyone assisting in the operation.
When the knife is held as directed there is not much danger of a
slip except at the end of the incision when, the resistance being
overcome, the knife goes through with a rush. To avoid this, pressure
should always be slackened toward the end of the incision. The main
incisions in the organs should be made with the brain-knife or short
amputation knife, by a long, sweeping cut made from heel to toe of
the knife-blade and beginning at the part of the organ farthest
from the operator, drawing the blade through the organ toward the
operator. For finer dissections the smaller scalpels are to be
employed, and in such cases the dissection-technique of fixed arm and
free finger movement must be used. In many places within the body
the cutting-edge of the knife should be directed outward rather than
inward so that underlying structures may not be injured. Often the
fingers of the left hand are used in such cases to take the place
of a grooved director. The application of these and other points of
technique will be elucidated in the chapters following, whenever
it is of advantage to use some especial method. In general nothing
should be done to disturb relationships until these have been noted,
and cuts should be made into organs in such a way that they may be
reconstructed in their original shape and condition.
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