You cannot work inside a patient if the rest of him gets in your way. To clear the field, you will have to use retractors. There are two kinds. One has to be held by an assistant, the other holds itself. Any blacksmith should be able to make you the simpler ones from ordinary steel. Strong retraction causes trauma, especially to the edges of the wound. So avoid it by appproaching deep areas through larger incisions.
RETRACTOR, Volkmann's rake, sharp, 4 prong, 220 mm, two only. These have sharp teeth like a cat's paw. Take care that they do not injure anything important.
RETRACTOR, Langenbeck, 13[mu]44 mm, two only. These are fairly small narrow deep retractors.
RETRACTOR, Czerny, double ended, four only. These have a flat blade at one end and two deep prongs at the other. They are thus more versatile than Langenbeck's retractors.
RETRACTOR, Lane's modified by Kilner, double ended, 150 mm, two only. This is a light general-purpose retractor with short shallow hooks at one end and a tongue at the other.
RETRACTOR, Gelpie, 170 mm, two only. A pair of these are very useful as general purpose retractors.
RETRACTOR, Morris, double ended, three only. This is a double ended abdominal retractor. Some surgeons prefer single-ended ones which are easier to hold.
RETRACTOR, Deaver's, plain handles, set of five sizes, one set only. These inexpensive general purpose abdominal retractors nest together, and so are easy to store.
RETRACTOR, malleable copper, set of 4 sizes, one set. These are strips of copper that you can bend into any shape to suit your needs.
RETRACTOR, Meydering, 178 mm, two only. These are for hand surgery and are used as a pair.
RETRACTOR, self-retaining, West's, straight, sharp-pronged, one only. This is a small self retaining general-purpose retractor.
RETRACTOR, abdominal, self-retaining, two-blade, adult, Gosset's, one only. The three blades of this large abdominal retractor can be arranged so that they support one another, and do not have to be held.
RETRACTOR, universal, Denis Browne, with (a) one frame 300[mu]240 mm, (b) one frame 300[mu]240 mm, (c) 3 hook-on retractors 50[mu]65 mm, (d) ditto 80[mu]90 mm, (e) ditto 98[mu]50 mm, (f) ditto 105[mu]35 mm, one set only. This is a useful but expensive retractor. It has a notched ring and hooked prongs, as in Fig. 4-4.
HOOKS, tendon, Harlow-Wood, 114 mm. These are for the hand set (4.12).
Fig. 4-4 RETRACTORS. You cannot operate on a patient if the surrounding tissues get in your way. These retractors will help to give you a clear field. Some have to be held, others hold themselves.