Hand Held Retractors: Blade Shapes and Depth Selection for Langenbeck, Farabeuf, Volkmann and Deaver

Langenbeck retractor and Farabeuf retractor

The Langenbeck retractor has a single blade at a right angle to a flat handle. It comes in different blade widths and depths and is a general-purpose choice for superficial to moderately deep wounds, for example in orthopaedics, plastics and general surgery. Its flat handle gives an assistant a secure grip.

The Farabeuf retractor is double-ended, with a short blade on each end, usually of different sizes. It is used for superficial incisions, where one blade is used for retraction and the other end is held by the assistant. Because both ends are used, it is compact and easy to count. REDA's retractor range lists Langenbeck, Farabeuf, Kocher and Volkmann hand retractors.

When choosing sizes, think of the blade as a tool for protecting what is behind it. A blade that is too narrow concentrates force on a small area of tissue, while one that is too wide may not fit the wound. Offering two or three widths of Langenbeck on the same tray is a simple compromise.

Volkmann and rake-type retractors

The Volkmann retractor is a rake retractor with several prongs, which may be sharp or blunt. It holds skin and subcutaneous tissue with little slippage, and it is useful when a flat blade would slide off. The sharp type holds more securely but can injure tissue, so choose blunt prongs near vessels or nerves.

Rakes come in 3- and 4-prong versions, and the choice depends on the width of tissue to be held. Because they hold by the prongs rather than by the blade, they are more suited to light tissues such as skin.

• Sharp prongs: secure grip, risk of tissue injury.
• Blunt prongs: gentler, may slip.
• Prong count and width should match the wound edge.

Deaver retractor and Richardson blades for deep wounds

The Deaver retractor has a wide, curved blade with a long handle and is designed for deep abdominal and pelvic retraction, where it holds organs away from the field. The Richardson blade is also curved, used to retract the abdominal wall and deeper structures. REDA's range includes Deaver, Kelly and Richardson hand retractors, as well as malleable ribbon retractors, Cushing nerve retractors and fine hooks.

For deep wounds, choose blade width and curvature to protect the structures at the edge, and remember that an assistant's arm becomes fatigued over a long case. A self-retaining frame may be the better answer if the retraction is constant. Read self retaining retractors for that choice.

Retractors surgical instruments: depth selection

A rough guide: for skin and subcutaneous layers use Farabeuf, Langenbeck or a rake; for muscle layers in limbs and trunk use Langenbeck or Volkmann with longer blades; for deep abdominal retraction use Deaver or Richardson; for delicate nerve work use Cushing and fine hooks; and for contour use malleable ribbon retractors.

Always select the blade length from the deepest point of the wound, and consider the width needed to protect the tissue rather than lever it. For a family overview see surgical retractors types and abdominal retractors Balfour and Kirschner.

Hand-held retractors should be passed to the assistant with the blade facing the correct way, and the scrub nurse should confirm the direction of pull during the operation so that tension is not applied at the wrong angle.

Care, inspection and ordering

Check each retractor for bent blades, burrs and sharp edges which can tear gloves or tissue. Hand-held retractors are simple to clean, but the junction between handle and blade should be examined for debris. Keep an accurate count on the table because retractors are large and easy to leave under drapes.

Beckfinity can help you prepare a quote for hand-held retractors from the REDA range in the sizes you need, subject to current MOHAP, DHA or DOH requirements.