In this paper, we extend the work of [Sela G, Schein S, Elber G. Real-time incision simulation using discontinuous free form deformation. In: Cotin S, Metaxas DN, editors. Medical simulation: International symposium, 2004. Lecture notes in computer science, vol. 3078. Springer; 2004. p. 114–123], in which we used discontinuous free-form deformations (DFFD) to artificially simulate real-time surgical operations. The presented scheme now uses accurate data from a finite-element model (FEM), which simulates the motion response of the tissue around the scalpel, during incision. The data are then encoded once into the DFFD, representing the simulation over time. In real-time, The DFFD is applied to the vertices of the surface mesh at the actual incision location and time. The presented scheme encapsulates and takes advantage of both the speed of the DFFD application, and the accuracy of a FEM. In addition, the presented system uses a haptic force feedback device in order to improve realism and ease of use.