Retraction Mechanics of Finochietto-Style Self-Retaining Thoracic Retractors

Guillaume Chanoit, Charles A Pell, Gil Bolotin, Gregory Buckner, Jeffrey P Williams, Hugh C Crenshaw

Research output: Contribution to journalArticle (Academic Journal)

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Abstract

Objectives: Analyze the mechanics of Finochietto-style retractors, including the responses of thoracic tissues during thoracotomy, with emphasis on tissue trauma and means for its reduction.
Methods: Mechanical analyses of the retractor were performed, including analysis of deformation under load and kinematics of the crank mechanism. Thoracotomies in a porcine model were performed in anesthetized animals (7) and fresh cadavers (17) using an instrumented retractor.
Results: Mechanical analyses revealed that arm motion is a nonlinear function of handle rotation, that deformation of the retractor under load concentrates force at one edge of the retractor blade, and that the retractor behaves like a spring, deforming under the load of retraction and continuing to force open the incision long after crank rotation stops. Experimental thoracotomies included retractions ranging from 50 to 112 mm over 30 to 370 seconds, generating maximum forces of 118 to 470 N (12-50 kgf). Tissue ruptures occurred in 12 of the 24 retractions. These ruptures all occurred at retraction distances wider than 30 mm and at forces greater than 122.5 N. Significant tissue ruptures were observed for nearly all retractions at higher retraction rates (exceeding ½-rotation of the crank per 10 seconds).
Conclusions: The Finochietto-style retractor can generate large forces and some aspects of its design increase the probability of tissue trauma.
Original languageEnglish
Article number45
Number of pages12
JournalBioMedical Engineering Online
Volume18
Issue number1
DOIs
Publication statusPublished - 16 Apr 2019

Keywords

  • Finochietto
  • Force relaxation
  • Retraction
  • Rib fracture
  • Sternotomy
  • Thoracotomy

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