The surgical assistant, a manual for students, practitioners, hospital internes and nurses . he wound, but notenough to bruise the tissues. When using sharp retractorsall the prongs should be sufficiently buried to prevent slippingand to avoid injury to the surgeons fingers; but if the super-ficial tissues are being retracted, the assistant should see that 134 The Surgical Assistant. the prongs are not forced through the skin from beneath. Asthe dissection or other manipulation proceeds deeper anddeeper or from one place to another, so the retractors shouldbe shifted—a process that again shoul
The surgical assistant, a manual for students, practitioners, hospital internes and nurses . he wound, but notenough to bruise the tissues. When using sharp retractorsall the prongs should be sufficiently buried to prevent slippingand to avoid injury to the surgeons fingers; but if the super-ficial tissues are being retracted, the assistant should see that 134 The Surgical Assistant. the prongs are not forced through the skin from beneath. Asthe dissection or other manipulation proceeds deeper anddeeper or from one place to another, so the retractors shouldbe shifted—a process that again should be conducted withdue regard to the operators fingers. ^Whenever expedient,it is best to insert a second retractor in the new site beforeremoving the first retractor from the abandoned a retractor is no longer serving a useful purpose itshould be removed; but if the assistant is in doubt as to itscontinued utility he had better leave it in position untildirected otherwise. In any case, a sharp instrument shouldnot be withdrawn from beneath the operators hand or Fig. 45. Use of retractors to expose to view a large visceral surfacethrough a relatively small opening. The assistant should early learn the value of lifting upwith the retractors. During laparotomies, especially, this Dissection. 135 simple procedure is of invaluable aid, in separating and dis-playing the various layers of the abdominal wall and theirbloodvessels and nerves, in drawing the parietal peritoneumfrom the viscera beneath, and in exposing the abdominal con-tents to visual exploration through a relatively small other things being equal, blunt retractors should be giventhe preference for use in the neighborhood of large blood-vessels and of intestinal or other delicate structures. Well-curved blunt hooks and blunt retractors should be chosen fordistracting a nerve or bloodvessel or a tense muscle (e. g.,the rectus abdominis). Obviously, a retractor should beselected with
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1905
