Rib Spreader Guide: Finochietto and Other Chest Retractors for Thoracotomy

How a Finochietto rib spreader works

The Finochietto rib spreader has a fixed arm and a moving arm connected by a toothed rack. A crank, turned by hand, drives the moving arm along the rack through a pinion, widening the gap between the blades. The blades hook into the intercostal space and hold the ribs apart without constant assistant effort.

This is useful because the chest wall resists opening and the force required is considerable. The opening is then locked by the ratchet so that the surgeon has a stable view. As with any retractor, the spread should be gradual and monitored to avoid rib fractures, particularly in older or osteoporotic patients.

Placement matters as well. The blades should sit in the intercostal space with the rack on the side that leaves the surgeon's working area clear, and soft tissue and the lung edge should be protected from the blades. Position and direction of the crank are usually agreed with the surgeon at the start of the case.

Finochietto, Finochietto-Burford and Cooley rib spreaders

REDA's cardiovascular and thoracic instruments section lists Finochietto, Finochietto-Burford and Cooley rib spreaders, as well as rib contractors for closure and Harrington and Price-Thomas bronchus clamps. The variants differ in blade shape, frame size and mechanics.

The Burford-type frame has a pronounced rack and wide, deep blades suited to larger exposures, and is often used for thoracic procedures. The Cooley retractor is generally used in cardiac and vascular work. Because the details of each model vary, confirm the dimensions of the item with the supplier rather than relying on the name alone.

• Finochietto: the classic thoracotomy rib spreader.
• Finochietto-Burford: a variant with its own frame and blades for wide exposure.
• Cooley: used in thoracic and cardiac exposure.
• Rib contractors: used to bring the ribs together for closure.

Chest retractor sizes and blade depth

Rib spreaders come in adult, small adult and paediatric sizes. The key parameters are the maximum spread, the blade width and the blade depth. Deeper blades are needed for thick chest walls and wider ones distribute the force over a larger area of rib. A paediatric frame is smaller and gentler.

Ask for the maximum opening in millimetres and the blade dimensions. If you serve both adult and paediatric patients, plan separate sizes and clearly label them. REDA's retractor range provides further context on retractor families from hand-held to self-retaining.

Check also how the blades attach. Some frames have fixed blades and others use interchangeable ones, which lets one frame serve different chest wall thicknesses.

Thoracic retractor versus sternal retractor

A thoracic retractor or rib spreader opens an intercostal space for a lateral or posterolateral thoracotomy. A sternal retractor opens the sternum after a midline sternotomy, as used in many cardiac operations. The two are different instruments with different frames, although they share the rack mechanism concept.

Do not use a rib spreader in place of a sternal retractor, or vice versa, because the geometry and load distribution differ. For cardiac sets, see cardiothoracic surgery instruments and vascular surgery instruments. For other retractors read self retaining retractors.

Care, inspection and buying

The rack and pinion need careful cleaning and light lubrication with an instrument-compatible lubricant. Check that the crank turns smoothly, the blades are not bent, and the ratchet holds under load. A frame that creeps closed during the operation is unsafe.

Request dimensions, blade sizes and the maintenance recommendations from your supplier, and confirm the current MOHAP, DHA or DOH requirements. Beckfinity can help you prepare a quote for rib spreaders and cardiothoracic instruments from the REDA range.