WOUND RETRACTORS hand held 1

Wound Retractors

Good exposure is one of the requisites of successful surgery. Instruments designed specifically to improve exposure are called wound retractors. They can be hand-held or self-retaining.

         The handle of the retractor is held by the assistant the retracting end is usually at a right angle to this. It smooth rounded with no sharp corner or edges to avoid injury to the tissues. The use of the retractor can be estimated from the depth to which this retracting end can go.

         The varieties in use are:

         •       Langenbeck (Fig. 8.90)

         •       Ollier (Fig. 8.91)

         •       Morris (Fig. 8.92)

         •       Kelly

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Nasogastric Tubes

Nasogastric

Tubes may have to be passed into the stomach, or even beyond, for decompression, sampling or delivery of drugs or food.

         Ryle’s tube is most commonly used for decompression of the stomach following abdominal surgery or for intestinal obstruction.

         The other tubes used are:

         •       Nasogastric (Figs 8.83A to C)

         •       Sengstaken (Fig. 8.84).

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CATHETERS

Catheters

The Foley catheter is a plastic two-lumen tube with an inflatable balloon. The balloon is inflated via a small channel.

         Suprapubic cystostomy is an alternative way of draining the urinary bladder. The Malecot catheter is well suited for this purpose. It is a rubber or latex tube with two wings at the tip. The de Pezzer catheter is based on a similar principle except that instead of wings, it has a bulbous end which can be straightened and recoils back when the wire introducer is removed.

The catheters in use are :

Foleys

Malecots

DePetzers

Tiemans

Gibbons

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TUBES

Tubes

Without endotracheal tubes modern anesthesia would be unthinkable. The traditional tubes of the Magill pattern are made of red mineralized rubber. Except for the smallest they all have an inflatable cuff near the distal tip to protect the lower respiratory tract form soiling as well as providing an air-tight seal. Each number refers to the internal diameter of the tube in millimeters.

         All tubes in the past have been made of rubber and have been recycled in practice by autoclaving. All these instruments and nasogastric tubes are now made of nonreactive plastic material and come presterilized in packs. These tubes are all disposable and thus do not require recycling.

         The tubes in use are:

         •       Endotracheal (Fig. 8.79)

         •       Uncuffed oral endotracheal tube (Fig. 8.80)

         •       Negus tracheostomy (Fig. 8.81)

         •       Chevalier Jackson (Fig. 8.82).

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NEEDLE HOLDERS

Needle Holders

Needle holders are modified box-lock forceps designed to hold curved needles. The surgeon should thus be able to manipulate the needle with ease during suturing near the surface (short needle holders) or at a depth (long).

         Since the function of needle holders is to grasp needles the instruments look like artery forceps:

1.      Serration at the tips to prevent slipping of needle.

2.      Shafts with rings for thumb and fingers.

3.      Locking device.

         Fine needle holders are damaged by large needles and small needles are damaged by large needle holders. The varieties in use are:

Mayo

Gilles

Naughton Morgan

Kilner

Mayo-Hegar

Microvascular

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GASTRIC & INTESTINAL CLAMPS

Gastric and Intestinal Clamps

Intestinal clamps are large self-retaining forceps with a primary function to occlude the bowel lumen.

         These clamps are indeed tissue forceps to allow firm holding of stomach and intestines.

         The non-crushing intestinal clamps do not cause permanent injury to the wall of the held viscus.

•       They occlude the viscus lumen and prevent spillage of infected bowel contents.

•       Temporarily occlude circulation in the bowel wall and thus keep the operative field free of blood.

•       Facilitate anastomosis by allowing the bowel ends to be approximated and manipulated.

The Varieties used are :

Doyans

Kockers

Lanes

Lane twin

Lloyds Davies rectal

Payers

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TISSUE FORCEPS

Tissue Forceps

Tissue grasping forceps are designed to grasp tissues without crushing them so as to allow their manipulation.

         They look like hemostatic forceps except that the blades approximate only at the tips leave a space along the shaft for the tissue held. The tips are usually made in the form of teeth to reduce tissue damage and improve grip.

         To facilitate dissection body tissues need to be held, maneuvered, freed and approxi­mated. These instruments have shafts, rings and locking device.

The ones inure are:

Allis

Lane

Babcock

Littlewood

Stile

Duval

DeBakey

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Hemostats

Hemostats are instruments that hold bleeders and stop bleeding
the varaities are:
Spencer Wells
Crile
Dunhill
Rochester-Oschner
Kocker
Monyhan

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Dissecting Forceps

Dissecting Forceps

These are also called thumb forceps because their shafts are closed by the surgeon’s thumb. They are used to grasp tissues in order to facilitate dissection or suturing and are divided into toothed and non-toothed.

         Dissecting forceps have two shaft and no joint the tip is serrated and may have teeth. When pressed they provide a firm grip on tissues but the firmness depends on how much pressure is put on the shafts. There is no locking catch on the shafts. The shafts spring back to open position when pressure is released. They are used to hold tissues while dissecting. The varieties are:
Canadian
Mitchell
Adson
Lane

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TREPHINES

Trephines are used to create openings into the cranium for access to the structures within. The burr holes can be used for obtaining biopsy material or for draining a collection of blood or pus.

         Burr holes can also be enlarged or intervening bone between burr holes removed to provide greater access to the brain.

The trephines in use are

Rawbothams

Buchanons

Hudsons burrs

Hudsons Brace

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SCISSORS 2

•       Potts (Fig. 8.38)

•       DeBakey (Fig. 8.39)

•       Microvascular (Fig. 8.40)

•       Satinsky (Fig. 8.41)

            Potts, DeBakey and Microvascular are the scissors used in vascular surgery.

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