Wound Retractors: Types and Uses
No safe procedure without a clear view. Wound retractors hold wound edges, muscles, mucosal flaps, cheeks or tongue aside and create access to the surgical site. In general surgery these are hand-held retractors and self-retaining retractors; in dentistry, cheek retractors, lip retractors and mouth gags are added. This guide explains the most important types, their typical features and when each retractor is useful.
Key points at a glance
- Hand-held retractors (wound hooks) are held by an assistant and can be repositioned continuously – e.g. Langenbeck, Roux, Farabeuf, Kocher, Volkmann.
- Self-retaining retractors stay open after insertion via a ratchet or screw – e.g. Weitlaner, Jansen, Gelpi, Beckman-Adson.
- Retractors come with a blade (smooth, flat) or with prongs (sharp, semi-sharp or blunt).
- In dentistry, cheek and lip retractors and the Minnesota retractor hold back soft tissue and flaps.
- Mouth gags keep the mouth open in a controlled way for longer periods, for example under sedation or during longer procedures.
Hand-held or self-retaining?
Retractors fall into two basic groups. Hand-held retractors are guided by an assistant. The advantage: direction and force can be adjusted at any time when the surgical field shifts. The disadvantage: they tie up one person, and holding force decreases during long procedures.
Self-retaining retractors have two or more opposing blades or prongs. After insertion, a ratchet, spring or screw keeps them open. They relieve the team but exert constant pressure on the tissue, so this pressure should be monitored during long procedures.
Blade or prongs?
The second distinguishing feature is the working end. Blade retractors have a smooth blade bent at a right angle. They distribute pressure over a larger area and protect tissue and flap edges. Rake retractors grip the tissue with several prongs. Sharp prongs hold skin and tough tissue securely; blunt prongs are gentler, for example near vessels and nerves. Many models are available in sharp, semi-sharp and blunt versions.
The most important hand-held retractors
Langenbeck retractor
The Langenbeck retractor is the classic blade retractor: a handle with a smooth blade angled at 90°. It is offered in various blade sizes and is used to retract wound edges and muscles in general surgery. In oral surgery it holds back mucoperiosteal flaps and the cheek, for example during osteotomies, implant placement or cyst removal. One variant is the Langenbeck-Mannerfelt retractor.
Roux and Farabeuf retractors
Roux and Farabeuf retractors are double-ended blade retractors with two ends of different sizes. They are shorter than the Langenbeck retractor and suitable for superficial wounds and smaller approaches. Roux retractors are often supplied as a set with graduated blade sizes, Farabeuf retractors usually in pairs. In our shop you will find the Farabeuf retractor.
Kocher and Volkmann retractors
Kocher and Volkmann retractors are rake retractors. They have several prongs and are available in sharp, semi-sharp and blunt versions. They hold skin, subcutaneous tissue and muscle securely without slipping. Examples are the Volkmann retractor and the Kocher retractor.
Other hand-held retractors
For deep abdominal and thoracic approaches, larger retractors such as Deaver, Richardson or Fritsch are used. Senn retractors combine a small blade with a rake end and are intended for small, superficial incisions. Fine skin hooks and single hooks are used to retract skin edges in plastic surgery.
Self-retaining retractors
Weitlaner
The Weitlaner retractor has two outward-curved arms with sharp or blunt prongs and a ratchet on the handles. It is suitable for small, shallow surgical fields. In our shop: Weitlaner retractor 13.5 cm and 10.5 cm.
Jansen
The Jansen retractor is smaller and is offered with sharp or blunt prongs. It is used for small approaches where a larger retractor would get in the way. See the Jansen retractor.
Gelpi
The Gelpi retractor has only a single sharp prong on each arm. It spreads at a single point and is suitable for deep, narrowly confined approaches, for example in orthopaedics and spinal surgery.
Adson and Beckman-Adson
Adson and Beckman-Adson retractors are long and sturdy, with toothed blades and a ratchet. They hold deep muscle layers apart, typically in spinal procedures. In our range: Adson retractor and Beckmann-Eaton retractor.
Retractors in dentistry
Cheek and lip retractors
Cheek and lip retractors hold the cheeks and lips back so that the dental arches are exposed. They are used during treatment, in orthodontics and for intraoral photography. You will find a selection among our stainless steel cheek retractors and the dental lip retractor.
Minnesota retractor
The Minnesota retractor (University of Minnesota) is a double-ended, curved cheek and flap retractor. It holds back mucoperiosteal flaps, cheek, lip or tongue during extractions and oral surgery, for example during wisdom tooth removal. In our shop: Minnesota cheek retractor and Cawood-Minnesota cheek retractor.
Mouth gags and bite blocks
Mouth gags keep the mouth open for longer periods. The Molt mouth gag works with a scissor mechanism and a ratchet; it is placed between the dental arches with padded tips and can be locked at any opening width. Smaller versions are available for children, such as the Molt mouth gag 9 cm for children. The Heister mouth gag opens via a central screw and was described as early as 1718 (Heister mouth gag). A bite block is the simplest form: it is pushed between the posterior teeth and passively supports the mouth opening. Mouth gags are used, among other things, under sedation or general anaesthesia, during longer procedures and for patients who cannot keep their mouth open themselves.
Comparison chart: wound retractors
| Instrument | Type | Working end | Typical use |
|---|---|---|---|
| Langenbeck | Hand-held | Smooth, right-angled blade | Wound edges, muscles, flaps in oral surgery |
| Roux / Farabeuf | Hand-held, double-ended | Two blades of different sizes | Superficial wounds, small approaches |
| Kocher / Volkmann | Hand-held | Several prongs, sharp to blunt | Skin, subcutaneous tissue, muscle |
| Weitlaner | Self-retaining, ratchet | Prongs on curved arms | Small, shallow surgical fields |
| Jansen | Self-retaining | Small prongs | Small approaches |
| Gelpi | Self-retaining, ratchet | One sharp prong per arm | Deep, narrowly confined approaches |
| Beckman-Adson | Self-retaining, ratchet | Toothed blades, long | Deep muscle layers, spine |
| Minnesota | Hand-held, dental | Curved, double-ended | Cheek, lip, tongue, flaps |
| Cheek / lip retractor | Dental | Wide, curved bows | Treatment, orthodontics, photography |
| Mouth gag (Molt, Heister) | Self-retaining, dental | Ratchet or screw | Prolonged mouth opening, sedation |
You will find the full range in the retractors category and under oral surgery.
Care and inspection
After every reprocessing cycle, check ratchets, springs and joints for function. A ratchet must engage securely and must not release under load. Prongs should be straight, undamaged and free of burrs. Padded tips on mouth gags are wear parts and are replaced as soon as they are torn or deformed. Further advice is given in our guide to care and reprocessing of surgical instruments; see also our overview of surgical forceps.
Frequently asked questions
What is the difference between a hand-held retractor and a self-retaining retractor?
A hand-held retractor is held by hand and can be repositioned continuously. A self-retaining retractor is inserted, opened and stays in position via a ratchet or screw.
What is a Langenbeck retractor used for?
For retracting wound edges, muscles and tissue. In oral surgery it holds back mucosal flaps and the cheek, for example during osteotomies, implant placement or cyst removal.
When should sharp and when blunt retractors be used?
Sharp prongs hold skin and tough tissue securely. Blunt prongs or smooth blades are gentler and are preferred when vessels, nerves or delicate structures are nearby.
What is a Minnesota retractor?
A double-ended, curved cheek and flap retractor used in oral surgery. It holds back the cheek, lip, tongue or mucoperiosteal flaps, for example during extractions.
What is a mouth gag used for?
A mouth gag keeps the mouth open in a controlled way when the patient cannot do so or when the procedure takes a long time – for example under sedation or general anaesthesia.