SHARP INSTRUMENTS 8

Rougines (periosteal elevators)

These are sharp edged instruments
They are used to elevate the periosteum from the surface of bone.
This procedure is required, before you can apply any cutting instrument to the bone.

Doyen’s periosteal elevator
It has a polygonal handle.
The blade is shaped like a hook

Uses the instrument is used to separate the periosteum from both surfaces of the rib (superficial & deep)
On completion the periosteum is stitched this helps healing.

Costotomes ( rib cutters)
These are instruments used to cut ribs.
The cutting edge of the instrument comes against a metal plate on going through
the rib.
This protects the deeper structures from the cutting edge.
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Resource

http://www.medema.co.uk/Products.aspx?ProductCatalogueName=Surgical_Instruments&ProductTypeName=Surgical_Instruments_Cardiovascular_Surgery&PCount=1&PID=15&PCountLink=0

SHARP INSTRUMENTS 7

Bone-cutting forceps

Bone-cutting forceps have two straight sharp edges and may have one or two fulcrums for double action. They can be used to cut small bones (ribs) or small rough edges of large bones.

Identification points
· These have a sharp cutting edge.
· These have strong joint to increase cutting force.
· These have a strong handle which is ridged to provide a firm grip.

What is the use of extra joints on the lever system?

Extra joints on the lever system are used to multiply the cutting power of the forceps so that less effort is required.

Uses
· To round off sharp edges of a cut bone.
· To smoothen the stump, in amputation of a bone.
· To cut into a cavity.

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RESOURCE http://www.zamaha.com/orthopedicmain.htm

SHARP INSTRUMENTS 6

Osteotome

Osteotomes are sharp instruments beveled on both sides and thus can spilt a bone as they can cut deeply.

Identification points

· Osteotome is like chisel in all ways.
· However, the sharp edge is beveled on both sides.


Uses
· It can cut through a bone and thus is used in osteotomy operations.


What are the types of osteotomy?

Linear or transverse osteotomy
Wedge or cuneiform osteotomy.


Bone gouge
Bone gouge has a curved cutting edge and, like chisel, can be used for creating a surface cavity on a bone.
This instrument has a handle, shaft and a cutting edge. It is similar in shape to a chisel or osteotomy, but its sharp cutting edge is curved or rounded.

Uses
· Bone gouge is used to obtain chips from a bone as in bone grafting.
· It can be used to enlarge the opening of a bone cavity (saucerise) and remove dead bone (sequestrum).
· It is sed to gouge mastoid bone (mastoiddectomy).

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SHARP INSTRUMENTS 6

Gigli Saw & Chisel

Gigli saw is another instrument used to carry out osteotomy. The instrument has two handles, and a lengthwise twisted stainless-steel wire is hooked to them.

Identification points
· It allows cutting bone in small spaces
· It does not damage soft tissue
· The cutting edge of the wire can be passed behind a bone
The two handles provide to-and-fro movement to cool the wire as it becomes hot during
the procedure

What operations have you seen with the use of Gigli saw?

· Brain surgery (osteoplastic flaps)
· Hemimandibulectomy or incomplete removal of the mandible
(Esmarch’s operation).
· McMurray’s osteotomy.

A power-driven oscillating bone saw is now being used in bone surgery.

Chisel
Chisels are sharp bone-cutting instruments bevelled on one side only.
Thus they cannot cut deep into a bone.

Identification points

· It has a sharp edge bevelled on one side.
· It has shaft above the edge.
· It has a handle (four sided) for hand grip.
· It has a head at upper end for hitting with mallet.
· It is used to cut and remove chips from bone as in sequestrectomy, SP nailing, or bone grafting.

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SHARP INSTRUMENTS 5

BONE-CUTTING INSTRUMENTS

Various bone-cutting instruments commonly seen in modern surgery are as follows:
Saw. Bone cutting forceps
Chisel. Rongeurs
Osteotome. Rougine
Bone gouge. Costotomes (Rib cutters)

Saws

All amputations of the extremities involve cutting through the central bone of the limb, thus the need for a saws.
These instruments have teeth on their cutting edge so as to facilitate cutting through bone.
Ferguson Saw has a broad blade and is used for big central bones of lower limb

Adams-Jones is a saw with a short narrow cutting blade and a blunt tip.
• Tip handle is designed to give a grip for the surgeon (Often called a pistol-grip handle) and a blade that can cut in a small space (neck of shaft femur).
• Powered bone saws allow bones to be cut in a short time with minimum effort. ( Stryker saw)
• Gigli saw is a cutting wire edge that cuts small spaces.
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SHARP INSTRUMENTS 4

SKIN GRAFTING KNIVES


Skin grafting knives are used for obtaining the superficial layers of skin (split thickness) for grafting.
They are therefore broad and lighter than amputation knives.
Those in use are

· Blair
· Humby
· Braithwaite
· Padgett’s dermatome

Skin-grafting knives are broad, but are lighter than conventional knives, they are used for obtaining large pieces of skin (split-thickness superficial) for grafting.
Some knives have guards, to prevent knife from going deep into skin.

Padgett’s dermatomes drum has adhesive on its surface, & adherent skin is cut on the drum, cut skin is then taken of the drum

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SHARP INSTRUMENTS 3

KNIVES

Amputation knives in use are:
· Liston’s
· Syme’s

Amputation knives are large, long, and heavy knives
They are used for surgical amputations thus have to go round the entire limb.
The bulk of the tissue such as muscles, vessels, and nerves, makes it necessary that these knives are large in size.
These knifes are of use limited to amputations
They are not included in any other sets

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