The practice of hand surgery requires appropriate instrumentation. The instruments used should be adapted in size to the tissue structures themselves, and the instruments should have an ergonomic handle for precision and comfort. Handles should be short because this surgery is performed in a superficial plane.
Here we will only describe the necessary instruments in common hand surgery procedures; instrumentation for osteosynthesis and instruments for microsurgery will be discussed in the corresponding chapters.
Equipment
Procedures in emergency hand surgery are extremely varied, from an intervention lasting only a few minutes, consisting of a simple exploration followed by suturing, to ambitious interventions consisting of free tissue transfers in emergencies.
Within this very broad spectrum, the equipment requirements are very diverse. To facilitate the work of sterilization, it is therefore necessary to have separate boxes of instruments, each adapted in its contents to a set of procedures.
Common Instruments for Hand Surgery
Outside of the specific instrument needs required for a bone or microsurgical procedure, the common instruments are presented, in our practice, according to two distinct types of packaging.
The “common” hand surgery box represents the same minimum instrumentation required for small emergency procedures, such as an exploration of a skin wound or an extensor tendon suture. It contains the following instruments:
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2 scalpel handles adapted to blades 11, 15 and 23 ( Fig. 3.1a )
Fig. 3.1
Common Instruments for Hand Surgery
(a) Top to bottom: Tubiana needle holder and classic needle holder, scalpel handles for blades 11, 15, 23 and 24. (b) Dissecting forceps (left to right): Adson-type toothed forceps, multitoothed forceps, nontoothed Adson-type forceps, tungsten atraumatic tissue forceps. (c) Kelly-type hemostatic forceps, right-angled forceps, Terrier forceps, Michon thin forceps. (d) Gillies single- and double-hook skin retractor, tendon hook, Morel-Fatio double-use retractor, Farabeuf retractor. (e) Stevens thin dissecting scissors, blunt dissecting scissors, Mayo scissors.
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2 needle holders, including a Tubiana needle holder ( Fig. 3.1a )
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2 Adson forceps; one nontoothed with thin edges, the other toothed, two teeth on one tip and one tooth on the other ( Fig. 3.1b )
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1 set of Kelly hemostatic forceps ( Fig. 3.1c )
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2 standard Farabeuf retractors ( Fig. 3.1d )
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2 Morel-Fatio retractors ( Fig. 3.1d )
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1 set of skin retractors in the form of single or double Gillies hooks ( Fig. 3.1d )
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1 pair of Mayo scissors ( Fig. 3.1e )
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1 pair of thin dissection scissors with curved edges and blunt ends ( Fig. 3.1e )
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1 pair of thin Stevens dissection scissors ( Fig. 3.1e )
This box is sufficient for most small, common emergency procedures. When a more complex intervention is planned, we use a “hand” box with more complete contents.
In addition to the instruments listed for the common surgery box, the hand box contains the following instruments:
