Cat's Paw, Senn-Mueller Retractor, Senn-Miller Retractor

 

Names

Commonly called as Cat's Paw

Other names are Senn - Mueller Retractor

Also known as Senn - Miller Retractor

Primary work

It is used in small surgeries mainly to retract the skin. Used mainly in hand and foot surgeries, plastic surgery, thyroid surgery etc. .

Secondary Uses

It is used to retract soft tissue structures below skin so the dissection is easier

Identification

It is a double ended retractor. On one side there is L shaped elongation which helps in soft tissue retraction. The other end has three bent prongs in opposite direction, which helps in skin retraction.

Sterilisation

By autoclave

Designer

Dr Nicholas Senn, Head of Surgery at Rush Medical College.

Keloid in front of chest

 Keloid 

Front of chest is a common site for it to develop 

Czerney Retractor

 

Primary use

It is used during closure of wounds especially laparotomy wounds to keep the tissues out . So that surgeon has good field of vision. As blades are small in size it can be used superficially mainly.

Identification

On one side it has solid blade and pronged blade on other side. If surgeon retract from pronged side he can visualise the structures in between the prongs eg any bleeder etc..

Sterilisation

by autoclaving

Metzenbaum Scissors

 

Blades 

Appreciate the curve, it may be straight also

Primary use

It is used by surgeons during surgery to cut soft and delicate tissues.

Secondary use

It is used for blunt tissue dissection during operation.

Sterilisation

It is made uo of stainless steel and sterilised by autoclaving.

During our (old) times sharp instruments were not autoclaved but they were kept in solution of phenol. And were used after washing.

Identification

These scissors have blunt tips. Blades can be curved or straight.

It has long shank/handle to blade ratio. Read also my post for parts of an instrument.

Not used for

These scissors are not used to cut sutures, papers, drains, plastics, heavy or hard tissues.

Difference from Mayo Scissors

These are similar to Mayo scissors but are lighter. The middle part is narrowed. The handles are much longer than blades.

Scissors in English Language

Scissor is the singular of same noun. But it is never used .

Default singular will be a pair of scissors.

Always call this instrument as pleural  such as scissors or a pair of scissors.

History

Metzenbaum word derives from its inventor Myron Firth Metzenbaum an america oral and reconstructive surgeon.

It is also referred to as Metzenbaum-Lahey forceps.

Dissection at Taj Mahal

 

Tension Pyo-pneumo thorax

 Treatment by urgent intercostal drainage. It was done and lots of pus came out in this case.

Sister Mary Joseph's Nodule

 Sister Mary Joseph's Nodule

It is because of distant metastases to umbilicus. Presence denotes advanced stage of malignancy. It is due to some intra-abdominal or pelvic malignancy.

Peri nephric Abscess

 

Multiple abrasions ( ? Anal fissures)

 Multiple abrasions are found after defecation for severe constipation. Although it is not well described in books.

Carcinoma Rectum with CT Scan report

 

Duodenal perforation as seen on operation table

 

Treatment is operative. Perforation is repaired with omentum.

Parts of an instrument

 1- Finger bows - To hold the instrument by surgeon 

2- Ratchet - use to keep the instrument closed 

3- Handle ( Shank) - Long narrow part connecting to operational end. 

4- Joint - Box lock or screw joint 

5- Blades or Jaws - Working end of an instrument 

6- Tip- May have teeth which allow firm grasping.

Large urinary bladder stone

 Large urinary bladder stone

Haemangioma finger

 

First line treatment nowadays is Beta Blockers

Mayo or Backkhaus Towel clips

 In both Mayo or Backhaus design is same but Mayo is larger in size.

Towel clips are very important in surgical operations.

Primary use

Towel clips are used to keep the drapes in position during surgery. pointed ends help in securing the drapes.

Secondary uses

These are used to secure various cords and pipes during general and laparoscopic surgery e.g., cautery cord, suction pipe, light cable, camera cable, endoflator tubes etc..

These are also some times used for retraction of tissues.

Also used in orthopaedics during reducing small bone fractures

To fix ribs in flail chest ( multiple ribs fractures)

Sterilisation 

By autoclaving

Identification

By pointed curved ends

Large Kidney stone

 Large Kidney stone

Xray of patient showing stone

Umbilical adenoma - Raspberry tumor

 Sometimes some tissue remains even after the tied stump is dried. The remaining tissue is named as umbilical adenoma. Due to its similarity with raspberry it is also known as Raspberry tumor.

Treatment is done by applying silver nitrate.

If patient is not improved then tissue is tied at base - It will dry slowly and finally fall.

Sebaceous cyst scalp

 A middle aged person presented with swelling over the scalp from last thirty years. History of trauma present. Also gave history of white cheesy material discharge from the swelling recently.

Diagnosis of burst sebaceous cyst can be made clinically. Further he needs CT scan followed by FNAC . Final treatment is excisional biopsy.

Carcinoma Breast with ulceration

 

Peri-umbilical hernia

 Large peri-umbilical hernia. Also noted is midline scar of previous LSCS.

Hydrocele - How to elicit transillumination

 Trans-illuminant swelling of scrotum - hydrocele.

Hydrocele is characterized by transillumination. If you put torch on lateral side in a dark room you may get this picture because of clear fluid. If there is collection of pus, blood or chyle you will not get this test positive.

Right Hydrocele

Neuro-fibromatosis

 Multiple neuro-fibromatosis in an old man. Biopsy is required for definitive diagnosis.

Chronic cholecystitis and cholelethiasis

Resected thick walled gallbladder with multiple pigment stones

 Ultrasound of same patients showing multiple stones and acoustic shadowes

Large ovarian cyst

 

Cheatle forceps

 Primary use

Cheatle forceps are used to pick sterilised instruments and drapes from boilers, drums and formaline chambers.

They are used to ensure that as each item is transferred, others are not infected.

Forceps are placed in a container of anti septic solution or savlon when not in use.

As you can see there is no ratchet in these forceps.