03.03 Handling of Instruments - Dissecting Forceps
If you are new to suturing, you will need to learn to recognize each of the instruments you are going to use, understand their function and practise the basic techniques of using them.
This section covers the dissecting forceps.
In this module
03.03 Dissecting Forceps
Dissecting forceps are used for manipulating tissues and needles. Many different sizes and designs are available, but all function similarly.
There are two essential types: non-toothed and toothed.
For most purposes other than holding skin edges, non-toothed forceps are preferable as they are less traumatic.
03.03.01 Principles
Dissecting forceps are like tweezers, with two springy metal legs joined at one end. Their free tips must meet accurately. These forceps are used to grasp tissue with delicacy and precision.
The forceps are usually held like a pen, in the non-dominant hand. They are used to manipulate tissues for the instrument in the dominant hand to dissect, cut or suture.
Toothed forceps require less pressure to adequately grip tough tissues such as skin, but the teeth may cause trauma to delicate tissue.
In general non-toothed forceps should be used whenever possible. The exceptions are when handling skin and bone.
03.03.02 Common Types of Dissecting Forceps
Adson plain forceps are non-toothed fine dissectors. They are used for grasping delicate tissues to dissect out nerves and vessels.
McIndoes forceps are essentially similar to Adson plain forceps but are slightly longer. They are considered easier to hold by many surgeons.
Adson toothed forceps are fine dissectors with teeth, for gripping tougher tissues, grasping fascia, subcutaneous fat and tendons. They are inappropriate for use on delicate tissue.
Gillies forceps are essentially similar to Adson toothed forceps, but are slightly longer and considered easier to hold by many surgeons. They too are inappropriate for use on delicate tissue.
Debakey forceps are atraumatic forceps widely used in general abdominal and vascular surgery. They have longitudinal serrations which maintain a good grip, with less tissue damage. They come in a range of lengths and widths and are suitable for handling bowel, blood vessels, bile ducts etc.
03.03.03 Practise Holding
Hold the dissecting forceps like a pen, in other words between your thumb and fingers, with the middle finger playing a pivotal role. Your hand should be relaxed and in the midway position between full pronation and full supination.
03.03.04 Things to Avoid
This section covers the most common problems encountered when learning to use dissecting forceps:
- incorrect hold
- and tissue damage
03.03.04.01 Incorrect Hold
Make sure you hold the forceps correctly. Holding them as shown here forces the hand into full pronation and causes strain.
03.03.04.02 Tissue Damage
Beware of causing tissue damage. Be as gentle as possible. Grasp the wound just deep to the edge, not actually on it.
For most purposes other than holding skin edges, non-toothed forceps are preferable as they are less traumatic.