SURGICAL INSTRUMENT sharp 6 Trephines Burrs

Trephines

Trephines in use are:

•       Rowbotham (Fig. 8.43)

•       Buchanan (Fig. 8.44)

•       Hudson burr (Fig. 8.45)

•       Hudson brace (Fig. 8.46)

         Trephines are used to create openings into the cranium for access to the structures within. The burr holes can be used for obtaining biopsy material or for draining a collection of blood or pus.

         Burr holes can also be enlarged or intervening bone between burr holes removed to provide greater access to the brain.

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SURGICAL INSTRUMENT sharp 5 Scissors

Scissors

The choice of surgical scissors is large. They can be long or short, strong or fine blunt or sharp pointed, straight or curved either on the flat side or on the edge.

         More expensive scissors have tungsten edges which are sharp, tough and long lasting.

         The choice will depend on many factors and the surgeon’s preference is perhaps of most importance.

•       For surgical cutting, short scissors are appropriate, and long scissors are used in deep dissection as in thoracic and pelvic surgery.

•       Curved scissors are more popular for dissection because, with the convexity of blades pointing away from the surgeon, structures being cut on both sides of the tip are visible.

         It should be realized that the longer the instruments the more pronounced is the tremor transmitted. The varieties of scissors in use are:

•       Mayo (Fig. 8.32)

•       McIndoe (Fig. 8.33)

•       Nelson (Figs 8.34A and B)

•       Metzenbaum (Figs 8.35A and B)

•       Lloyd Davies (Fig. 8.36)

•       Abel (Fig. 8.37)

•       Potts (Fig. 8.38)

•       DeBakey (Fig. 8.39)

•       Microvascular (Fig. 8.40)

•       Satinsky (Fig. 8.41)

         Potts, DeBakey and Microvascular are the scissors used in vascular surgery.

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Surgical Instruments Sharp 4 bone cutters

         Bone cutter has two straight sharp edges and may have one or two fulcrums for double action. They are used to cut a small bone or the irregular edge of long bone.

Rongeurs

Rongeurs are instruments with two curved cutting edges with one or two fulcrums for nibbling the edges of a bone to enlarge the cavity created.

         Those in use are:

         •       Horsley (Fig. 8.20)

         •       Cairns (Fig. 8.21)

         •       Killearn (Fig. 8.22)

         •       Pennybacher (Fig. 8.23)

         •       Bateman (Fig. 8.24).

Rougines

Rougines are sharp edged instruments. They are used to lift the periosteum from the surface of a bone. This is essential prior to using any cutting instruments on the bone.

         Roughine (periosteal elevators) in use are:

         •       Farabeuf (Fig. 8.25)

         •       Semb (Fig. 8.26)

         •       Tudor Edwards (Fig. 8.27)

         •       Doyen (Fig. 8.28).

Rib Cutters

Rib cutters are:

•       Vehmehren (Fig. 8.29)

•       Doyen (Fig. 8.30)

•       Giertz (Fig. 8.31).

         Access to the chest for procedures within the thorax or for draining of an infected pleural cavity may require rib cutters.

         These are of different shapes to match requirements of different ribs. There is a surface that protects the pleura from injury by the cutting edge of the cutter.

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SURGICAL INSTRUMENTS Bone cutting saws chisels osteotomes gouges

Bone Cutting Instruments

All amputations of the extremities involve cutting through the central bone of the limb, thus the need for a saw. These instruments have teeth on their cutting edge to facilitate cutting through bone.

•       Fergusson amputation saw (Fig. 8.10)

•       Adams-Jones saw (Fig. 8.11)

•       Stryker oscillating saw (Fig. 8.12)

•       Gigli saw (Figs 8.13A and B).

Other Bone Cutting Instruments

•       Chisels are sharp bone cutting instruments beveled on one side only, thus it cannot cut deep into a bone. Smith-Peterson chisel (Fig. 8.14) beveled one side.

•       Osteotomes are sharp instruments beveled on both sides and thus can split a bone. McEwan osteotome (Fig. 8.15) beveled both sides.

•       A gouge has a curved cutting edge and like a chisel can be used to create a surface cavity on a bone. Smith-Peterson gouge (Fig. 8.16).

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