TY - JOUR
AU1 - Crumplin, Michael K H
AB - The clear advantage of this group of retractors is that it obviates the need for a hand-held instrument and gives a stable clear view of the operative field. These retractors are invaluable for surgeons working in remote areas or in areas of high surgical turnover in war zones, for example, where assistance may be difficult to find. There is a range of these instruments both in size and function. These retractors can exert considerable pressure on tissues, and so the surgeon has to be careful not to unwittingly trap or damage vulnerable structures in the blades or claws. With the larger and more forceful self-retaining retractors (SRRs), care is required not to crush the retracted edges. The two principal types of SRR are those employed in body cavity surgery, and the smaller instruments, which are mainly used in orthopaedic, spinal or more superficial operations. Balfour abdominal self-retaining retractor There are around six other varieties of this useful SRR, but the Balfour model (Fig. 1) is fairly well known. Basically, it is a three-bladed instrument which can be aligned in two directions. The two bars are fixed and permanently joined to one of the side blades. One bar stabilizing the structure has a hinged strut at its free end, which allows removal of one side blade, and a clamp, which fixes the middle curved solid blade in the desired position. This take-apart facility is useful for cleaning the instrument. The central wider curved blade allows both retraction and spreading at one extreme of a linear incision. The closed instrument is placed gently in the incision and the three blades carefully opened, positioned appropriately, and the screw is then tightened to fix the central blade. To prevent any pressure damage on skin, fat, and muscle, dry or damp surgical swabs can be placed between the SRR and the incised abdominal wall. The instrument has a trivalve 7-inch opening, 2.5-inch deep lateral blades and 1.75-inch centre blade. Fig. 1 Open in new tabDownload slide Balfour abdominal self-retaining retractor Courtesy of the Royal College of Surgeons of England. Donald Church Balfour (1882–1963) was a well qualified Canadian surgeon who specialized in gastrointestinal work. Recommended to the Mayo brothers in Rochester, he not only became Director of the Division of General Surgery at the Mayo Clinic, but married William Mayo’s daughter. He designed operating tables and stents for colonic anastomosis. A prolific writer and educator, he directed the Mayo Foundation for Education and Research. His department trained around 1500 medical officers for the World War II. Awarded many honours, he survived tuberculosis and died from a myocardial infarct. Denis Browne self-retaining retractor The Denis Browne ring retractor (Fig. 2) stands out because of its simplicity and effectiveness in securely holding the edges of incisions by pulling in four directions. It was developed by the addition of new sizes of ring and a variety of blade shapes. Its wide adoption by many surgeons outside the paediatric field reflects the genius of its inventor. The blades are attached by hooks to the serrated edge of the steel ring, allowing varied strength of pull and position. Fig. 2 Open in new tabDownload slide Denis Browne self-retaining retractor Courtesy of the Royal College of Surgeons of England. Sir Denis John Wolko Browne is widely known as the ‘Father of Paediatric Surgery’ in Britain for good reason. Although not the first full-time paediatric surgeon in the country, he was among a small group of surgeons who dedicated themselves to the specialty, which evolved in the National Health Service from 1948. As consultant surgeon at the Hospital for Sick Children (Great Ormond Street), he led the creation of the British Association of Paediatric Surgeons in 1953. He designed many different surgical procedures and instruments, many of which have been superseded. Burford–Finochietto’s thoracic self-retaining retractor This is a robust ratchet-operated rib spreader with changeable blades (Fig. 3). It is opened by gradually turning the handle attached to the base of one of the blades. It may break ribs and, sometimes, proactive rib division with rib shears will allow improved access, with less trauma. It is employed in sternotomy or lateral chest incisions. Fig. 3 Open in new tabDownload slide Burford–Finochietto’s thoracic self-retaining retractor Courtesy of the Royal College of Surgeons of England. Thomas Burford (1907–1977) was born in Missouri and pioneered thoracic surgery in World War II, championing the practice of decortication. After the war he worked as Director of the Division of Thoracic and Cardiovascular Surgery in Washington, where he took an interest in coarctation of the aorta and oesophageal caustic strictures. Enrique Finochietto (1881–1948) was an Argentinian surgeon who trained in Europe, to where he returned to help in the Great War. He later became chief surgeon at the Rawson Hospital in Buenos Aires and Professor of Surgery in that city. He developed 67 surgical items and instruments. An avid fan of the tango, he contracted syphilis during travels abroad, which may have hastened his premature demise. Travers self-retaining retractor This 8-inch long retractor (Fig. 4) proves useful particularly in minor orthopaedic and superficial general surgical procedures. It opens on a ratchet, controlled by the finger bows, and has turned-back claw blades that securely grip the retracted structures. The spreading of the retractor arms is released by lifting a lever on the ratchet mechanism. Fig. 4 Open in new tabDownload slide Travers self-retaining retractor Courtesy of the Royal College of Surgeons of England. There were two well known, yet unrelated, surgeons named Travers. Benjamin Travers was one of the early ophthalmic surgeons, and William Travers (1838–1906) was an obstetrician and gynaecologist. He worked at the Chelsea Hospital for Women and in private practice. William was a founder the British Gynaecological Society. This retractor is named after him. Joll’s thyroid self-retaining retractor This well designed specialized retractor (Fig. 5) is most commonly used in open thyroid surgery. Following a transverse neck incision for thyroidectomy, upper and lower skin flaps are fashioned. The instrument with its two arms—one upper, the other lower, with ratchet-controlled sharp clips at each end—is placed ready across the neck. The sharp clip ends are closed, piercing the middle of each edge of the two flaps. The retractor arms are then spread by turning the grooved central screw mechanism, which can be locked. This manoeuvring gives an adequate diamond-shaped access wound to the strap muscles above the thyroid. Fig. 5 Open in new tabDownload slide Joll’s thyroid retractor with locking nut Courtesy of the Royal College of Surgeons of England. Cecil Augustus Joll (1885–1945) was born in Bristol and studied medicine at Bristol, University College Hospital London, the London Hospital, and in Paris. In 1931, after training in Leicester and Birmingham, he became senior surgeon at the Royal Free Hospital. He garnered a considerable number of consulting surgeoncies at other London and suburban hospitals, and had a large private practice. He worked in Paris and other hospitals in the Great War and in the World War II, he slept in the Royal Free every other night during heavy bombing raids. He took a particular interest in thyroid and gastric surgery. Acknowledgements The author is indebted to E. MacKinnon, retired paediatric surgeon, for his assistance with this article. Disclosure The author declares no conflict of interest. © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Self-retaining surgical retractors
JF - British Journal of Surgery
DO - 10.1093/bjs/znac442
DA - 2022-12-23
UR - https://www.deepdyve.com/lp/oxford-university-press/self-retaining-surgical-retractors-daZea76Gwt
SP - 1122
EP - 1124
VL - 110
IS - 9
DP - DeepDyve
ER -