Fabrication of Metal Instruments

I. Stainless steel
is an alloy of iron, chromium and carbon and it may also contain nickel, manganese, silicon, molybdenum, sulfur and other elements to prevent corrosion y Chromium resistant to corrosion y Carbon hardness, reduces corrosion-resistant effects of Chromium y Iron fabrication of surgical instruments y Stainless steel instruments are fabricated with one of the three types of finishes before passivation: 1. Mirror finish shiny, reflects light; resist surface corrosion 2. Anodized finish aka Satin finish; dull and glare proof 3. Ebony finish black which eliminates glare; used in laser surgery to prevent beam reflection II. Titanium y Non-magnetic and inert; harder, stronger, lighter in weight and more resistant to corrosion than stainless steel III. Vitallium y Alloy of cobalt, chromium, and molybdenum y Suitable for orthopedic devices and maxillofacial implants IV. Other metals y Brass, silver or aluminum y Tungsten carbide laminating cutting blades or as inserts on the functional tips or jaws of some instruments V. Plated instruments y A shiny finish can be put on a forging or tooling of an iron alloy. y Prone to rupturing, chipping, and spontaneously peeling; used infrequently today
y

Classification of Instruments
Cutting and Dissecting
y

Cutting has sharp edges; used to dissect, incise, separate, or excise tissues; should be kept separate from other instruments to prevent injuries

1. Scalpels y With reusable handle and a disposable blade y Types of blades: y No. 10 used most often; has a rounded cutting edge along one side and fits on Nos. 3, 7 and 9. Nos. 20, 21 and 22 blades are the same shape but larger y No. 11 has a straight edge that comes to a sharp point. It fits on Nos. 3, 7 and 9 handles y No. 15 has a smaller and shorter curved cutting edge than No. 10 blade. y No. 23 has a curved cutting edge that comes to more of a point than Nos. 20, 21, and 22 blades 2. Knives y Have a blade at one end, like a kitchen paring knife and the blade may have one or more cutting edges y May be used for specific purposes: cataract knife, for adenotome or dermatome, for Gastrointestinal multifunctional instrument that cuts and staples tissue 3. Scissors y May be straight, curved or angled, as well as either pointed or blunt; handles may be long or short y May be used to cut or dissect tissues and others are used to cut other materials y Types of Scissors: y Tissue/ Dissecting scissors sharp blades; Blades needed to cut tough tissues are heavier. Curved or angled blades are needed to reach under or around structures. y Suture scissors have blunt points to prevent structures close to the suture from being cut y Wire scissors have short, heavy blades; cut stainless steel sutures. Heavy wire cutters are used to cut bone fixation wires y Dressing/ Bandage scissors cut drains and dressings to open items such as plastic packets 4. Bone Cutters and Debulking Tools y Cut into or through bone and cartilage which include: y Chisels

y y y y y y y y

Osteotomes Gouges Rasps Files Drills Saws Reamers The purpose of these instruments is to decrease the bulk of firm tissues

5. Other sharp Dissectors y Biopsy forceps and punches remove tissue for pathologic exam; used through and endoscope y Curettes remove tissue or bone by scraping with the sharp edge of the loop, ring or scoop on the end y Snares dissect tissue such as tonsil by putting a loop of wire around; the wire cuts the pedicle as it retracts into the instrument 6. Blunt Dissectors Separate friable tissues or tissue planes

Grasping and Holding I. Tissue forceps y Used to pick up or hold soft tissues and vessels; securely grasp but prevent injury to tissues 1. Smooth forceps y Aka thumb forceps or pick ups; resembles tweezers; will not injure delicate structures 2. Toothed forceps y Differ from smooth forceps at the tip; rather than being serrated. They have single tooth on one side that fits between two teeth on the opposing side y Provide a firm hold on tough tissues, including skin 3. Allis forceps y Has a scissors action y Each jaw curves slightly inward and there is a row of teeth at the end y The teeth hold tissue gently but securely 4. Babcock forceps y At the end is rounded to fit around a structure or to grasp tissue without injury

II. Stone forceps

y y y

Curved or straight Grasp calculi (kidney stones) Have blunt loops or cups at the end of the jaws

III. Tenaculums
y

Curved points at the end of the jaws penetrate tissue to grasp firmly

Clamping and Occluding

I. Hemostatic forceps
y y y y

Have two opposing serrated jaws and controlled by ringed handles Hemostats clamp blood vessels. Straight or curved Crushing clamps crush or clamp blood vessels; straight, curved or angled; serrations may be horizontal, diagonal or longitudinal Non-crushing vascular clamps used to occlude peripheral or major blood vessels temporarily, which minimizes tissue trauma

Exposing and Retracting I. Handheld Retractors y Malleable retractors flat length that may be bent to the desired angle and depth for retraction y Hooks single, double or multiple; used to retract skin edges during a wide flap dissection such as facelift or mastectomy II. Self-Retaining Retractors y Holding devices with two or more blades can be inserted to spread the edges of an incision and hold them apart

Suturing or Stapling I. Needle Holders y Grasp and hold curved surgical needles y Has short, sturdy jaws for grasping a needle; jaws are usually straight II. Tungsten Carbide Jaws y Eliminate the twisting and turning of the needle in the needle holder III. Crosshatched Serrations y The serrations on the inside surface of the jaws are crosshatched rather than grooved, as in hemostat y Crosshatching provides a smoother surface and prevents damage to the needle IV. Smooth Jaws y No serrations; used with small needles Staplers I. Clip Appliers y Used to mark tissue and to occlude vessels or small lumens of tubes II. Terminal end Staplers y Designed for closing the end of a hollow organ with a double staggered line os staples III. Internal Anastomosis Staplers y Designed to connect hollow organ segments to fashion a larger pouch or reservoir IV. End-to-end Circular Staplers y Designed to staple two hollow, tube-like organs end to end to create a continuous circuit