1991;7(1): 056-057

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INNOVATIONS

Modified Sternal Retractor and Internal Mammary Artery Forceps for Myocardial Revascularisation

S o l o m o n Victor

Two instruments which facilitate myocardial revas- cularisation using the internal mammary artery are described. A sternal retractor modified by elevating its ratchet limb affords excellent exposure of this artery. A mammary holding forceps helps to hold the pedicle with one hand, and facilitates trimming of the artery, arteriotomy, and placement of initial sutures.

Rapid mobilisation of the internal mammary artery (IMA) for myocardial revascularisation neces- sitates improved exposure with a simple gadget. This has been achieved by a simple modification of an ordinary sternal retractor. Holding the IMA pedicle usually requires two hands and two forceps. A single forceps has been designed to hold the pedicle secure- ly with one hand to facilitate arteriotomy and sutur- ing.

The Instruments

The Retractor: A Favaloro sternal retractor is modified by introducing a double bend in the

transverse rack-and-pinion limb where it is attached to the fixed longitudinal retract!on arm. This elevates the rack-and-pinion shaft along with the movable arm by 2 cms. This simple modification affords ex- cellent exposure (Fig. 1) of the IMA on either side by positioning the rack-pinion and crank towards the foot- or the head-end.

The Forceps: Usually the IMA pedicle, after separation from the costal cartilages and division, is held by an assistant using two hands and two pairs of forceps. The IMA holding forceps (Fig 2) has two limbs in its jaw, which obviate the necessity for two separate dissecting forceps. Atraumatic serrations help in holding the pedicle neatly and firmly, facilitating trimming, arteriotomy and passage of initial sutures.

Both the instruments have been routinely used by us for the past seven years and we continue to find them extremely useful and convenient in har- vesting and grafting the mammary artery (Fig 3).

From The I |eart Institute, Madras, India. Address for correspondence: Dr. Solomon Victor, 15, East Street, Kilpauk Garden Colony, Madras 600 010, INDIA.

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VICTOR Modified sternal retractor and IMA forceps

Fig 1. Modified sternal retractor with an elevated rack-and-pinion shaft Rg 2. IMA forceps with an enlarged view of the working end. in use for the dissection of internal mammary artery.

Fig 3. Operative view showing the IMA forceps in use.

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