Army-Navy Retractors: The Original Surgical Exposure Tools

Introduction to Army-Navy Retractors

Army-navy retractors are a type of surgical instrument that are commonly used during surgical procedures to provide exposure and access to the surgical site. They are named army-navy retractors because they were originally designed for use by army and navy surgeons during wartime procedures. Today, these versatile retractors are a staple instrument in operating rooms across many surgical specialties.

What Are Army-Navy Retractors?

Army-navy retractors consist of a flat, slightly curved blade attached to a handle. They come in a variety of blade sizes, shapes, and angles to fit different purposes. The curved blade can be inserted into an incision and then leveraged open to push tissue out of the way, exposing the underlying surgical site.

Unlike self-retaining retractors like rakes or weits that stay in place on their own, army-navy retractors require the surgeon or an assistant to manually hold them in place during the procedure. The benefit of these manual retractors is that the surgeon has complete control over the amount and direction of retraction.

Key Features of Army-Navy Retractors

Army-navy retractors have the following key features:

• Sturdy handle with textured grip to provide stability and prevent slipping
• Available in different blade sizes - from very small to wide and broad
• Range of blade shapes: flat, curved, angled, pointed, or double-ended
• Smooth, polished blades with rounded edges to prevent tissue trauma
• Made of durable stainless steel that can withstand repeated sterilization
• Allow for significant tissue retraction strength and control

Common Types of Army-Navy Retractor Blades

There are many different army-navy retractor blade variations used for specialized retraction purposes:

• Richardson - flat, rectangular blade ideal for abdominal and orthopedic procedures
• Morris - semicircular blade that conforms nicely to the chest cavity for cardiac surgery
• Deaver - tapered, pointed blade excellent for delicate dissection and procedures
• Volkmann - curved, malleable blade that can be shaped as needed for liver retraction
• Gelpi - self-retaining retractor with two adjustable arms for tissue and organ retraction
• Weitlaner - retracts in two directions with two prongs good for exposing fascia layers
• Ragnell - tiny rectangular blade for neurosurgery and delicate procedures
• Doyen - features a ribbed backside used for grasping and manipulating tissue

Uses of Army-Navy Retractors in Surgery

Thanks to their versatility, army-navy retractors are used in almost every specialty of surgery. The ability to control the degree and direction of retraction makes them a critical tool for achieving the proper exposure and access to tissues and organs during procedures.

Abdominal Surgery

Wide army-navy retractors are heavily utilized in open abdominal surgery cases. The broad, flat blades can retract vertically to open the abdomen and expand the working cavity. Common abdominal procedures relying on army-navy retractors include:

• Bowel resection
• Colectomy
• Adhesiolysis
• Hernia repair
• Liver resection

Curved blades conform nicely to the abdomen for retraction while preventing tissue trauma. Especially useful are the Volkmann and Gelpi retractors.

Orthopedic Surgery

In orthopedic surgery on joints like the knee and hip, army-navy retractors allow surgeons to work in tight spaces. The Richardson retractors are commonly used for distraction and exposure in procedures like:

• Total hip arthroplasty
• ACL reconstruction
• Meniscus repair
• Spine surgery

Smaller, delicate blades can provide the fine tissue control needed for hand surgery cases as well.

Neurosurgery

Precise control over delicate neural structures is critical in neurosurgery. Specialized army-navy retractors like the Ragnell provide wide but gentle retraction of soft brain tissue and small blood vessels. Neurosurgeons depend on army-navy retractors for complex cases like:

• Craniotomy
• Excision of brain tumors
• Aneurysm clipping
• Deep brain stimulation

The malleable blades allow surgeons to carefully maneuver around critical cortical areas of the brain.

Cardiothoracic Surgery

Procedures within the chest require special retractors that can expose tissue while working around the cage of ribs. Curved army-navy retractors like the Morris perfectly contour to the chest cavity, providing wide retraction for surgeries such as:

• Coronary artery bypass
• Heart valve repair/replacement
• Lobectomy
• Pneumonectomy

Surgeons also appreciate army-navy retractors for dividing and retracting individual ribs during thoracotomy.

Plastic and Reconstructive Surgery

Army-navy retractors enable plastic surgeons to perform delicate tissue handling and dissection required in procedures like:

• Facelift
• Breast augmentation
• Tummy tuck
• Liposuction
• Hand reconstruction

The thin, tapered blades provide gentle traction of skin flaps while minimizing trauma to preserve vascularity of tissue.

Proper Use of Army-Navy Retractors

While army-navy retractors are commonplace in the OR, they must be used properly to avoid complications like bleeding and tissue damage.

Blade Insertion and Placement

• Enter the incision slowly and visualize the blade tip at all times
• Avoid forcing the blade bluntly through tissue layers
• Gently sweep any overlying tissue out of the way
• Ensure the blade is securing the desired tissue before retracting
• Check for any vessels crossing the planned retraction path

Applying Retraction

• Retract gradually, allowing time for tissue to stretch safely
• Use smooth, steady traction - no jerky movements
• Stop immediately if tissue appears damaged or overstretched
• Use caution when retracting near major blood vessels
• Enlist a surgical assistant if extensive retraction is needed

Maintaining Exposure

• Periodically reassess the position and tension on retractors
• Relieve pressure between long periods of retraction
• Adjust blade angle or position if visualization becomes obscured
• Use care when removing retractors to avoid tissue injury

Transferring Retractors

• Always verbally communicate transfers between team members
• Pass the retractor carefully to maintain tissue position
• The receiver should confirm visually that they have control
• Smoothly transition control over the retractor

Advantages of Army-Navy Retractors

There are many benefits to using army-navy retractors for surgical exposure:

• Versatile - Available in a large variety of blade shapes and sizes
• Customizable retraction - Surgeon controls amount and direction of retraction
• Delicate handling - Can retract tissue layers gradually and gently
• Non-obstructing - Low profile leaves surgical site visible and accessible
• Allows palpation - Surgeons can manually feel anatomy unlike self-retaining retractors
• Cost-effective - Reusable instruments help lower procedural costs

The combination of strength, customizability, and delicate handling make army-navy retractors a versatile, vital instrument in the surgical toolkit of most specialties.

Disadvantages of Army-Navy Retractors

However, army-navy retractors have some limitations as well:

• Manual use - Requires constant presence of surgical assistant for retraction
• Fatigue - Can be tiring for assistants during long, complex cases
• Position maintenance - No ability to lock retraction angle in place
• Limited exposure time - Prolonged retraction can damage tissue
• Bleeding risk - Vessel injury with excessive traction
• Infection risk - Difficult to fully clean crevices and joints

Self-retaining retractors reduce the personnel and fatigue factor but sacrifice the versatility and customization offered by army-navy retractors.

The Future of Surgical Retraction

While simple and effective, army-navy retractors have remained largely unchanged in design over the past century. However, new innovations are aiming to enhance surgical exposure while reducing the risks and limitations of manual retractors.

Advancements include:

• New materials - Lighter carbon fiber or titanium to reduce hand fatigue
• Robotic retractors - Can maintain precise retraction force and position without constant human input
• Dynamic retraction - Self-regulating tension that adjusts to changing tissue properties
• In-blade lighting - Illumination at the tip improves visualization
• Tissue perfusion monitoring - Sensors that detect compromised blood flow to prevent ischemia

Army-navy retractors have been a trustworthy exposure tool for generations of surgeons. While newer technologies hold promise to advance retraction, traditional designs continue to play an integral role in surgical specialties thanks to their simplicity, customization, and delicate tissue control.

FAQs

What are army-navy retractors used for?

Army-navy retractors are used to manually retract tissue and expose surgical sites during operations. The curved blades can retract skin, fat, muscle, organs, bone, and other tissue out of the way to improve visualization and access for the surgeon.

What procedures use army-navy retractors?

Army-navy retractors are utilized in nearly all surgical specialties. They are commonly used in abdominal, orthopedic, neurologic, thoracic, cardiac, plastic, reconstructive, and other surgeries.

How does an army-navy retractor work?

The curved blade is inserted into the incision and leveraged open to push tissue out of the surgical site. The surgeon or assistant holds the retractor handle to manually maintain the desired retraction exposure throughout the operation.

What are the different army-navy retractor blade types?

Common blade types include Richardson, Morris, Deaver, Volkmann, Ragnell, Weitlaner, Gelpi retractors, and more. Each blade has a specialized shape and design for different surgeries and tissue planes.

Are army-navy retractors reusable?

Yes, army-navy retractors are reusable surgical instruments. They are made of durable stainless steel that can withstand repeated sterilization between uses through methods like autoclaving.