Page 18 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

Chapter 1 · Surgical principles and instrumentation

Rongeurs • DeBakey needle holders: These are more delicate
needle holders with serrated jaws for finer surgery.
Lateral or ventral bulla osteotomy may require the use of • Ryder (micro) needle holders: These are extremely
VetBooks.ir Double-action rongeurs are more powerful and have a • Castroviejo needle holders: These are round-handled
rongeurs (Figure 1.10) to aid precise removal of bone.
delicate needle holders for use with very small needles.
smoother action than single-action rongeurs. The ideal
rongeurs for middle ear surgery would have a powerful
mechanism, suitable for microvascular surgery.
mechanism and relatively delicate jaws. Rongeurs may also needle holders with extremely fine tips and no ratchet
be useful for the collection of specimens when performing
a biopsy of soft and hard tissues in the oral cavity. Vascular clamps
Vascular clamps (Figure 1.11) are non-crushing clamps that
• Lempert rongeurs: These are standard single-action may be used for temporary occlusion of large vessels.
small rongeurs with 2–3 mm wide jaws, available These clamps are available in small and large sizes and
straight or curved. may be straight, curved, right-angled or tangential. The
• Ruskin rongeurs: These are double-action rongeurs DeBakey pattern is commonly used to provide an atrau-
with 3, 5 or 7 mm wide jaws. matic tip for vascular clamps. Other atraumatic tip config-
• Kerrison rongeurs: These are double-action rongeurs urations are available, including the Cooley pattern.
with a long delicate blade that operates with a unique Tangential clamps (e.g. Satinsky clamps) provide
action. The upper blade is cutting and slides along the partial occlusion of a vessel wall whilst allowing blood to
lower blade, which ends in a protective footplate.
flow through the remaining portion. They may also be use-
ful for placing across a right atrial appendage that requires
resection. DeBakey tangential vascular clamps can be
placed on an elongated soft palate for resection of excess
tissue or along the palatine tonsil attachment for tonsil -
l ectomy. Doyen intestinal forceps are useful to clamp
the body of the tongue to provide temporary haemostasis
whilst the distal tissue portion is resected and the cut
edge repaired.

1.10 Rongeurs. 1 = Lempert; 2 = Ruskin; 3 = Kerrison.

Needle holders
Needle holders are used to grasp and manipulate curved
needles. It is important to choose the correct size for
the needle being used. Large needle holders can distort 1.11 Vascular clamps. 1 = straight; 2 = right-angled; 3 = tangential.
or break small needles. Using too large a needle in deli-
cate needle holders will damage the instrument. Gold-
handled needle holders have a tungsten carbide insert in
the jaws, which provides increased durability and an Surgical curettes
excellent grip. Needle holders that can be locked on to the Curettes may be used for the removal of debris and granu-
needle, usually by a ratchet mechanism, are recom- lation tissue from a soft tissue wound, a bone surface or
mended to prevent slippage of the needle. The needle defect, an alveolar socket after tooth extraction, during ear
should not be able to move in the jaws of the instrument surgery to remove tissue remaining inside the tympanic
when the ratchet is locked to the second tooth. A needle bulla and for turbinectomy during rhinotomy procedures.
holder without a ratchet mechanism may be used for very
delicate or microvascular surgery to prevent any motion • Spratt curette: These curettes have round cups and
at the instrument tip. are available in various sizes.
• Volkmann curette: These curettes are double-ended
• Mayo–Hegar needle holders: These are standard with round or oval cups and are available in various
sturdy needle holders, which are available in a variety sizes.
of sizes.
• Olsen–Hegar needle holders: These needle holders Dental explorer and periodontal probe
have an integral scissor blade, which enables them to
cut sutures. A dental explorer is used to assess the structural integrity of
• Halsey needle holders: These are sturdier needle a tooth and explore the presence of pulp exposure. A perio-
holders with serrated jaws, often used in head and dontal probe is used to measure the depth of periodontal
neck surgery. pockets and the height of excess gingiva (Reiter, 2013).

9

Ch01 HNT.indd 9 31/08/2018 10:22