Surgical instruments

SURGICAL INSTRUMENTS L. W. KAY Two instruments which are utilitarian in function, simple in design and adaptable for oral surgery purposes have just been marketed by leading manufacturers of surgical instruments. They are a double-ended stainless-steel retractor (manufactured by both Thackray Ltd and Down Bros and Mayer and Phelps Ltd) and the Davol/Simon Dermatome (producted by Davol International Ltd, Clacton-onSea). The former (Fig. i) is a versatile lightweight instrument for the retraction of buccal flapsmr 4 cm in length with a maximum width of r-5 cm, minimum taper and blade dimensions of 3-2 cm and 2"3 cm. The smooth right-angled ends are contoured inwards at their tips to 'cup' the soft tissues behind the blade and prevent lateral slipping or sliding. The retractor has no sharp edges or metal teeth which 'dig in' and sometimes tear the undersurface of the flap. A good exposure of the operative site is obtained and handling is comfortable with the wrist working in a balanced position. Because of its facility and cheapness, the Davol/Simon dermatome (Fig. 2) is likely to prove a popular buy with many oral surgeons practising the standard technique of epithelial inlay. The suggested hospital price for the model and recharger unit is lowm£Io.5o. The set is, of course, incomplete without a sterile disposable cutting-head, and the cost of this component varies depending upon the number ordered in the form of peel-back packages (Io per box). In practical terms, however, the purchase of this essential accessory item would amount to an approximate outlay of a little over £ I per head. Armed with the complete functioning instrument deftness becomes automatic, so that the tiro needs only a modicum of technical instruction to ensure proficiency. Split skin grafts (partial thickness skin grafts; Thiersch graft) can be taken swiftly and surely from any part of the body. An electric dermatome can also be used safely in operating suites, except in the presence of an explosive volatile anaesthetic such as ether or cyclopropane; but in view of alternative maintenance agents in modern anaesthesia, this potential hazard can easily be circumvented. The three simple steps in preparation for the graft procedure are as follows: (I) The unsterile cordless, self-powered handle is removed from the wall-mounted recharger and placed in a sterile polythene bag which is supplied with the sterile head. (2) The disposable cutting-head (shorn of its protective 'safety jacket') is then attached to the power handle by a simple manoeuvre, i.e. after centring the drive shaft in the cutting gear, the power handle is then pushed into the funnel end of the head until a click is heard. (3) Now, the instrument is ready for operation. The special cutting-head is accurately pre-set to produce uniform grafts calibrated to a skin thickness of o-or 5 inch. To achieve the correct plane the face of the cutting element is placed horizontal to the lubricated donor site. The 'on' button is pushed home, and with a firm downward pressure and smooth movement the cut is made at a rate of about ] inch per second. The device cuts strips to a maximum width of I ~ inches, and their length is limited only by the available donor area. The I54

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sheet of graft comes slowly up over the razor and can be lifted clear while held steady with tissue-holding forceps. After the surgical exercise is completed and the cutting-head discarded, the power handle is wiped with a cloth and returned to

FIG. I

FIG. 2

the recharger installation. This simple machine provides instant and accurately calibrated split thickness grafts from suitable donor surfaces. The necessary expertise is quickly acquired after a short demonstration, but a resourceful oral surgeon who has consulted the explicit instruction sheet can scarcely fail, at his first attempt, to cut a successful graft.