Nonslip Breast Retractors with Cautery Tip Cleaners

One of the challenges in breast surgery is to obtain the appropriate operative field because surgeons have to dissect deep spaces through minimal incision sites. In addition, muscle is a contractive structure, so retraction of slippery muscle tissue by stainless steel retractors can be a hindrance during surgery. To overcome this situation, breast retractors with toothed ends are made and sold ([Fig. 1]) [[1], [2]]. However, they are not produced in South Korea so they are not easy to obtain. They are also too expensive. The aim of this study is to introduce nonslip breast retractors constructed from conventional retractors and cautery tip cleaners.

Fig. 1 Epstein breast retractor (ASSI, with permission from Accurate Surgical & Scientific Instruments Co. [[1]]).

Cautery tip cleaners (Xodus, New Kensinton, PA, USA) are composed of five layers ([Fig. 2]). Beginning with the top layer, the layers are nonslip paper, polyurethane foam, X-ray detectable material, acrylic adhesive tape, and release line. The top layer, nonslip paper, provides an abrasive surface. Using this surface, the cautery tip cleaners are intended to be used to remove and clean the material from the tips of mono-polar and bi-polar cautery probes. Sometimes the cautery tip cleaners are used in surgical debridement to make a clean, flat, and even wound bed [[3]]. The procedure for constructing nonslip breast retractors using cautery tip cleaners is as follows:

• Prepare normal retractors and cautery tip cleaners.

• Trim the tip cleaners according to the size of the retractors.

• Dry off the tip cleaners and the blade of the retractors completely for a firm bond between the two surfaces.

• Remove the release line and put the tip cleaners on the retractors.

Fig. 2 Composition of cautery tip cleaners (Xodus).

Tip cleaners could be applied to any retractors ([Fig. 3]). These retractors can be used for the dissection of the submuscular space. It is necessary to retract the muscle with care because the muscle fiber could be injured by the rough surface of the tip cleaner. When the retractors need to be adjusted, the blade of the retractors should not be slid while gripping, but should be removed from the muscle and moved to another point. If the number of the tip cleaners remaining on the retractors when closing the wound is not same as the initial number, a portable X-ray should be used to locate and retrieve the lost tip cleaners.

Fig. 3 Various types of nonslip breast retractors with cautery tip cleaners.

During the period from February 2011 to February 2013, we applied this technique in 98 breast reconstruction cases ([Fig. 4]). In all of the cases, we achieved a better operative field, so that it was easier to dissect the muscle and control the bleeding in the submuscular area. We have never had any problems related to the tip cleaners, such as injury to the muscle during surgery. In any other breast surgery or submuscular dissection, the new retractors provided us with a better operative field and allowed the operation to be performed with greater ease.

Fig. 4 Retraction of slippery muscle by new breast retractors (black arrow) on immediate breast reconstruction.

New retractors can be constructed easily during surgery, so they are very cost-effective. They are attractive items to surgeons, providing a stable operative field and facilitating speedy, safe, and simple submuscular dissection.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Presented at the Oriental Society of Aesthetic Plastic Surgery 13th International Congress, October 5-7, 2012 in Seoul, Korea.

• References

• 1 Epstein MD. 2013 Accurate Surgical & Scientific Instruments (ASSI) epstein breast retractors [Internet]. 2013. cited 2013 Feb 20 New York: ASSI; Available from. https://www.epsteinplasticsurgery.com/pdf/ASSI-Epstein-Breast-Retractor.pdf
• 2 Accurate Surgical & Scientific Instruments (ASSI). Breast retractors without fiber optic or suction [Internet]. cited 2013 Feb 20 New York: ASSI; Available from. https://www.accuratesurgical.com/docs/breast_instrumentation/retractors/index.asp
• 3 Choong MY, Wu HF, Lin CY. et al. Using electrosurgical tip cleaner to debride before skin grafting. Am Surg 2011; 77: E296-E297

Publication History

Received: 21 February 2013

Accepted: 18 March 2013

Article published online:
01 May 2022