Retractors 05 Parts of retractors

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Retractors 05 Parts of retractors

This subsection has text and images from an interactive multimedia training program on basic surgical skills called 
PrimeSkills in Surgery.
You can use this subsection on its own or follow the whole program (further details at the end of this subsection).

A retractor has two parts:

The part that pulls.

And the part that holds or grips the tissues.

We describe various types of retractor below, in increasing order of complexity.

1 The simplest form of retractor is the assistant's unaided hand.

01392010 hand retractor.jpg

The wrist does the pulling.

The hand and the fingers hold back or grip the tissues.

2 The assistant's hand aided by using a swab or pack to increase friction.

01392012 swab retractor.jpg

eg.: When retracting skin with a gauze swab.

Inside the abdomen, a large gauze pack aids the assistant's hand and fingers in holding back slippery

bowel and other organs.

3 Nonspecialised instruments in the forceps family, with ordinary finger and thumb rings and jaws to grip the tissues being retracted.

01392014 cholecystectomy forcep.jpg

eg.: Cholecystectomy forceps on the rectus sheath.

Haemostats on aponeuroses.

4 More specialised forceps with jaws modified to grip the tissues more delicately.

01392016 Littlewood forcep.jpg

eg.: Littlewoods forceps on skin flaps.

Babcock's forceps on bowel.

5 Retractors with specialised handles for stronger pulling and blades instead of jaws.

01392018 Deaver retractor.jpg

The handle is usually designed to fit in the hand rather than on the fingers.

This gives a stronger grip than finger rings.

The handle is made as comfortable as possible to permit efficient retraction for long periods.

The handle is usually angled with respect to the blade to give the maximum retraction.

The blade is designed to retract the tissues without damaging them.

The blade often has a lip to improve the grip on slippery tissue.

01392020 Morris retractor.jpg

Eg.: Morris retractor

The deeper the tissues needing retraction, the longer the blade.

01392022 Kelly retractor.jpg

Eg.: Kelly retractor.

For shallow wounds, the blade is replaced by a claw (cat's paw) or a hook (skin hook).

01392024 cat's paw.jpg

When retraction of a wide area of delicate tissue is needed, the blade may be replaced by a wire plate, or a frame reminiscent of an egg whisk.

01392026 Lung retractor.jpg

Eg.: Lung retractor.

5 The most complex retractors are self retaining retractors.

01392028 Finochietto retractor.jpg

Eg.: Finochietto retractor

They replace the assistant's muscle.

They are usually placed and adjusted by the surgeon, but do need some attention from the assistant.

See Retractors 09 Retractors in practice

They usually consist of a pair of ordinary retractors.

The handles are connected with a joint, and the two blades oppose one another.

There is some form of ratchet, worm or friction device to keep the blades apart.

Some have blades attached to a ring.

Others are attached to the operating table.

Once the blades are correctly positioned, no more physical effort is needed.

They act as extra assistants in larger operations.

Next subsection, click on Retractors 06 How retractors work
Last subsection, click on  Retractors 04 Introduction
Surgical Education and Training page, click on Surgical Education and Training
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