رترکتور چنگکی بکمن
رترکتور چنگکی بکمن ( beckman retractor ) :
نوعی رترکتور خودکار قفل دار دارای حلقه انگشتی در دسته خود است . بازو های لولا دار و آرواره های آن هر یک دارای 3 چنگک می باشد .
چنگک های آن می توانند تیز یا بلانت باشد .
برای مشاهده صفحه اینستاگرام مامایی می توانید بر روی این لینک کلیک نمائید .
برای مشاهده و خرید انواع ابزار های جراحی عمومی می توانید بر روی این لینک کلیک نمائید .
beckman retractor
موارد استفاده رترکتور چنگکی بکمن :
جهت کنار زدن بافت عمقی ( مثل جراحی های ستون فقرات و شکستگی های پروگزیمال فمور ) کار برد دارد .
توضیحات بیشتر درباره رترکتور چنگکی بکمن :
همیشه این وسیله را به گونه ای به جراح تحویل دهید که چنگک های آن به سمت پایین قرار داشته باشد .
!!!!!!!!!! هشدار !!!!!!!!!!!
چنگک های آن ممکن است خیلی تیز باشد . باید مراقب نوک تیز آن بود زیرا قادرند دستکش ها و یا پوست را سوراخ کند .
برای مشاهده محصولات دیگر برروی کلمه ی “ورودبه سایت“ کلیک نمایید./
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Tips and Pearls
1. A thorough preoperative evaluation is critical to a successful rotator cuff repair.
A complete physical examination, review of plain radiographs, and MRI provide meaningful information to plan surgery and counsel patients preoperatively.
The size of tear and the degree of tendon retraction and muscle atrophy can suggest the degree of difficulty
in attempting to repair the rotator cuff and the possible need for postoperative abduction brace
immobilization.
2. Check passive range of motion preoperatively and under anesthesia.
Gentle shoulder manipulation may be necessary to release capsular adhesions.
If adhesive capsulitis is severe, consider a staged manipulation and subsequent rotator cuff repair to minimize post-surgical loss of motion.
3. Mobilization of the rotator cuff tendon along its superior and inferior surfaces and release of a contracted coracohumeral ligament is important to minimize undesirable tension on the tissue and repair.
4. Define the anterior and posterior aspects of the rotator cuff tear and advance and secure these areas first.
This closes the tear and relieves tension on the repair at the tuberosity.
5. A secure deltoid repair to the acromion is as important as the rotator cuff repair in restoring shoulder
strength and function.
رترکتور چنگکی
رترکتور چنگکیWhat To Avoid
1. Make sure the patient is properly positioned on the operating room table.
Avoid excessive cervical traction and brachial plexus traction.
Ensure proper padding of all bony prominences to minimize risk of neuropraxias.
2. Avoid fracturing the acromion during either the acromioplasty or deltoid reattachment.
3. Do not mistake the flimsy bursal tissue for the rotator cuff tendon and use it in the cuff repair.
4. Avoid inadequate or insecure repair of the deltoid to the acromion.
exercises Operative Technique Approach
1. Position the patient on the operating room table as outlined above.
2. Prepare and drape the entire arm and shoulder girdle “free.”
3. Carefully outline prominent anatomic landmarks:
coracoid process, clavicle, AC joint, acromion and scapular spine.
4. Draw the planned skin incision with a marker.
The incision should extend 2 in from the lateral aspect of the anterior third of the acromion toward the lateral tip of the coracoid process acromion halfway between the anterolateral and posterolateral corners of the acromion.
Place the skin incision in Langer’s lines that parallel the lateral border of the acromion (see Fig. 1–1).
5. If an excision of the distal clavicle is indicated, move the incision approximately 1 cm medial to the tandard incision (see Fig. 1–1).
6. Infiltrate the skin and subcutaneous tissue with 1:200,000 concentration of epinephrine.
7. Incise the skin and subcutaneous tissue down to the deltoid fascia. Develop the prefascial plane to expose the entire anterolateral corner of the acromion and the lateral aspect of the deltoid.
If AC joint excision is planned, dissect further medially to expose the distal 2 cm of the clavicle.
8. Split the deltoid muscle in the raphe between the anterior and middle deltoid. Begin at the anterolateral corner and extend the dissection distally 2 to 3 cm.
The direction of the split is approximately perpendicular to the skin incision.
Consider placing a stay suture to avoid injuring the terminal branches of the axillary nerve (see Fig. 1–2A).
9. Starting from the split, release the deltoid subperiosteally along the anterior acromion using an electrocautery.
Start several millimeters back from the anterior edge of the acromion (see Fig. 1–2A).
Bovie electrocautery is more effective than sharp dissection for this step.
10. Release the superficial and deep deltoid fascia. Tag these with heavy nonabsorbable suture, which aids
retraction and deltoid repair.
Carefully coagulate the acromial branch of the thoracoacromial artery that is usually encountered near the anterolateral acromion between the superficial and deep deltoid.
11. Completely detach the coracoacromial ligament, usually along with the deep deltoid fascia, from
its attachment on the acromion (see Fig. 1–2B).
Usually it is not necessary to dissect these out separately.
12. Extend the deltoid release past the AC joint. Expose the distal clavicle when distal clavicle excision is
planned (see Fig. 1–2A).
13. Release bursal adhesions with a blunt instrument or an index finger.
1398/6/11 SEO & APLOAD BY M.F
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