Surgical instruments are essential helpers on the way to better results. As in the surgical procedure itself, also with the equipment, even small changes in details may make a big difference concerning handling, potentially affecting the outcome. Over many years of practicing rhinoplasty, the author has repeatedly asked the manufacturer to optimize the design of instruments, leading to modified or even new instruments, which made life in the operating room easier.1
Two of the author’s youngest new developments are (i) a fine-pointed scissors for skin preparation, with a special extra add-on for the columella incision (Fig. 1) and (ii) a modification of the classical Aufricht retractor, making it self-retaining (Fig. 2).
- (i) The inverted-V incision in the columella skin is an important step with the open approach. It needs a precise, clear cut in a stable setting. Many surgeons used to stabilize the columella skin after elevation with a branch of scissors or some other instrument, like a chisel, when conducting the incision. It may then be disadvantageous as the scissors’ branch is rounded, and in the other case, there is a need for changing the instrument.
The author has modified the design of the scissors such that it has a “working plate” attached to the side of its inferior branch. After preparation of the columella skin, the scissors now can be left in place, where it is spread, and the little plate serves as a stable and safe basis for the cutting knife (Fig. 3).
- (ii) It is a disadvantage of the standard Aufricht retractor that it must constantly be held by the surgeon or an assistant. This fact may block 1 hand of the surgeon who sometimes would like to use both hands for surgery.
Therefore, the author has attached a bendable metal band to the retractor, which is curved over the patient’s head and held in position by an added weight at its cephalic end (Fig. 4). Thus the retractor stays in place by itself, and the surgeon has both hands free. If required, the instrument is easily removed and quickly reinserted.
The instruments described here (manufacturer: Karl Storz, Tuttlingen, Germany) have helped the author to make rhinoplasty procedures easier (See video, Supplemental Digital Content 1, which displays the use of rhinoplasty scissors and self-retaining bendable nasal skin retractor at surgery. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A225). They have become a natural part of the surgical armamentarium of the author, and they might even contribute to the achievement of better results.
1. Berghaus A. New instruments for rhinoplasty: operating mirror and alar guiding set. Plast Reconstr Surg. 2006;117:22242225.