Bonney Tissue Forceps
Heavy, non-locking thumb forceps with broad, toothed tips that can help grasp thick fascia and skin in open surgery. Bonney-pattern jaws vary by catalog item: one Teleflex model has 1×2 teeth and a 3.3 mm tip, while another is listed with 2×3 teeth. The name is associated with British gynecologic surgeon Victor Bonney (1872–1953).[1][2][11]
Design
- Tip width. broad relative to fine Adson/Gerald patterns; check the catalog item rather than assuming a universal 3–4 mm width.
- Teeth. 1×2 or other catalog variants, including 2×3; prominent teeth may grip tough tissue but can puncture delicate tissue.[11]
- Shaft. heavier than DeBakey, Adson, or Gerald; transverse cross-hatched serrations along the inner proximal shaft for finger grip.
- Spring tension. firm, stiffer than Gerald or DeBakey, matching the forces needed to grip thick tissue and providing tactile feedback on fascial thickness.
- Length. Model-specific.[11]
- Material. surgical-grade stainless steel; reusable autoclavable and disposable variants.
Why Heavy Teeth — The Grip-Trauma Trade-Off
Prominent teeth can provide firm purchase on tough tissue but can also cause focal injury. An experimental sheep-stomach jaw study found greater grip with larger teeth at the cost of more tissue trauma; a separate liver-tissue finite-element model found less simulated damage but more slipping with smooth wave jaws. Neither tested Bonney forceps in patients.[3][5] The relevant handling considerations are:
- Fascia tolerates more traction than delicate tissue in an experimental suture-loading model. Rodrigues measured about 11.4 N at first visible damage for porcine fascia versus 1.25 N for fallopian tube.[4]
- Secure grip can reduce slippage. Marucci's sheep-stomach jaw experiment found a grip advantage from larger teeth at the cost of more tissue trauma.[3]
- Thick fascial edges may need a firm, focal hold, but traction and jaw compression still require restraint; choose the instrument to match tissue thickness and access.
Bonney vs Adson-Toothed — The Frequently-Confused Distinction
| Feature | Bonney | Adson-Toothed |
|---|---|---|
| Tooth pattern | Prominent; 1×2 or other model | Usually finer 1×2 |
| Tip width | Broad; model-specific | Narrower; model-specific |
| Shaft | Heavy with cross-hatched grip | Lighter, delicate |
| Spring tension | Stiff | Moderate |
| Clinical niche | Deep fascial closure | Skin / superficial fascial handling |
Comparison Across the Forceps Family
| Feature | Bonney (model-specific teeth) | Adson-Toothed (1×2) | Gerald-Toothed (1×2) | Russian | DeBakey |
|---|---|---|---|---|---|
| Tip width | Broad | Narrower | Fine | Round, model-specific | Narrow, model-specific |
| Tooth size | Large, deep | Moderate | Fine, shallow | None (serrations) | None (serrations) |
| Tissue trauma | Tooth puncture possible | Tooth puncture possible | Tooth puncture possible | Compression/shear possible | Compression/shear possible |
| Grip security | Strong on suitable thick tissue | Strong on skin | Depends on tissue | Depends on tissue | Depends on tissue |
| Best tissue | Thick fascia, heavy skin | Skin, moderate fascia | Tunica, adventitia, graft | Bladder, ureter, broad grasp | Vascular, delicate |
| Typical suture pairing | Determined by closure, not forceps | Determined by closure | Determined by repair | Determined by repair | Determined by repair |
| Primary use | Fascial closure, laparotomy | Skin / fascia closure | Microsurgery, fine reconstruction | General tissue handling | Vascular, delicate tissue |
See also: Adson, Gerald, Russian, DeBakey.
Primary Applications
Fascial Closure After Laparotomy — The Quintessential Use
During midline-laparotomy closure, Bonney forceps can grasp and present thick fascial edges for suturing if the jaw size and force are appropriate. The STITCH 13-year follow-up randomized 559 patients to continuous small-bites closure (5 mm × 5 mm, 2-0 polydioxanone on a 31-mm needle) or large bites (10 mm × 10 mm, looped polydioxanone on a 48-mm needle). Cumulative incisional hernia incidence was 34% versus 49% (HR 0.61, 95% CI 0.43–0.86), and hernias were smaller at final follow-up (mean 25 versus 43 mm).[6] The 2022 European and American Hernia Societies guideline suggests continuous small-bites closure with a slowly absorbable suture for elective midline laparotomy and states that the technique implies a suture-to-wound length ratio of at least 4:1.[7] Neither source compared Bonney with another forceps or required Bonney to achieve small bites.
Skin Closure (Thick Skin)
Trunk and extremity skin where thick dermis benefits from tooth grip without the need for excessive squeeze.
Abdominal Wall / Hernia Surgery
- Primary fascial closure or mesh placement in ventral / incisional hernia repair.
- Component-separation handling of the external oblique aponeurosis, rectus sheath, transversalis fascia.
Urologic Applications
- Open radical or partial nephrectomy. Flank and midline fascial closure.
- Open radical prostatectomy. Lower-midline / Pfannenstiel fascial closure.
- Open cystectomy with urinary diversion. Large midline laparotomy closure.
- Renal transplantation. Handling the thick fascia of the Gibson iliac-fossa incision.
- Gerota's fascia. Secure grasp during open renal surgery.
- Vaginal cuff and dense pelvic scar during redo prolapse / fistula surgery (the original gynecologic-tradition use).
- Pubovaginal sling harvest. Rectus-sheath fascial grasp during strip retrieval.
Gynecologic Surgery
Open hysterectomy and cesarean fascial closure were the original Bonney indications.
Victor Bonney — Historical Note
Victor Bonney (1872–1953) was a British gynecologic surgeon at the Middlesex Hospital and the Chelsea Hospital for Women in London. He is credited with advancing radical surgery for gynecologic malignancy and myomectomy, and the forceps that bear his name were used for major abdominal gynecologic surgery.[1][2]
Advantages
- Firm grip on suitable thick tissue from prominent teeth.[3]
- Potentially less slippage on thick fascia when the teeth engage, balanced against focal tooth trauma.[3]
- Tissue-edge presentation. Broad tips can help expose the fascial edge.[6]
- Tactile feedback. Heavy construction and stiff spring let the surgeon gauge tissue thickness and tension.
- Durability. Heavy construction tolerates repeated sterilization and heavy use.
- Ergonomics for forceful grasping. Broad shaft and cross-hatching prevent slippage in the surgeon's hand.
Limitations
The prominent teeth can create puncture wounds. Avoid or use a more delicate instrument for:
- Bowel serosa / mesentery. Risk of perforation or serosal tear.
- Vascular structures. Risk of intimal injury.
- Ureteral or bladder mucosa. Risk of mucosal disruption / leak.
- Fragile edges of a watertight anastomosis. Tooth puncture may disrupt the repair.
- Cosmetically sensitive skin. Tooth marks may leave visible scars (use Adson-toothed or finer instead).
- Microsurgical tissues. Vas, nerve, fine vessels (use Gerald or jeweler's).
The wide tip also obscures the field in confined spaces, and Bonney forceps are open-surgery instruments with no role in laparoscopic or robotic surgery.
Excessive squeeze still causes crush injury beyond what the teeth alone produce; engage the teeth, then stop. Gentle tissue handling is part of contemporary SSI-prevention practice.[8][9][10]
Variants and Related Instruments
- Bonney pattern. Catalog-listed 1×2 and 2×3 variants; check the exact dimensions and jaw configuration.[11]
- Lane forceps. Another heavy toothed tissue-forceps pattern.
- Ferris-Smith. Heavy multi-toothed (3×4 or 4×5) for orthopedic and neurosurgical use on periosteum, dura.
- DeBakey-Brown. Hybrid serrated-but-broader-tip design bridging atraumatic and toothed.
- Cushing toothed. Fine neurosurgical toothed variant; far more delicate than Bonney.
Practical Tips
- Palm grip. Use a palm grip rather than a pencil grip; it provides the squeezing force and stability fascial work demands.
- Engage the selected toothed tip squarely with enough contact for controlled purchase; inspect whether the actual model has 1×2 or 2×3 teeth and avoid excessive penetration.
- Rotate to evert the fascial edge toward the surgeon after grasping, as is customary during closure.
- Stop squeezing once the teeth engage. The teeth provide the grip; additional compression only crushes the tissue between the jaws.
- Pair with a heavy needle driver (Mayo-Hegar) for 0 or 1 looped PDS on a large needle; smaller needle drivers and 2-0 PDS on a 31-mm needle are appropriate for small-bites technique.[6]
- Instrument passing. Present the closed tips safely with the handle accessible; Bonney thumb forceps have no finger-ring hoop.
Role in Modern Practice
Bonney forceps remain an available open-surgery option for firm fascial handling, including abdominal incisions and rectus-fascia harvest.[6][7] A smaller or less traumatic forceps may be preferable for thin edges or confined exposure.
Summary — When to Use, When to Avoid
| Use Bonney for | Avoid Bonney for |
|---|---|
| Midline fascial closure (linea alba) | Bowel serosa, mesentery |
| Pfannenstiel fascial closure | Vascular structures |
| Flank-incision fascial closure | Ureteral / bladder mucosa |
| Thick trunk or extremity skin | Cosmetically sensitive skin |
| Hernia-repair fascial edges | Microsurgical tissue (vas, nerve, fine vessels) |
| Gerota's fascia | Renal parenchyma |
| Rectus sheath / external oblique aponeurosis | Peritoneum (tears easily) |
| Pubovaginal-sling fascial harvest | Watertight / tension-free anastomoses |
References
1. Kirkup J. "The history and evolution of surgical instruments. VII. Spring forceps (tweezers), hooks and simple retractors." Ann R Coll Surg Engl. 1996;78(6):544–52. PMID 8943642
2. El-Sedfy A, Chamberlain RS. "Surgeons and their tools: a history of surgical instruments and their innovators. Part IV: pass me the forceps." Am Surg. 2015;81(2):124–7. doi:10.1177/000313481508100222
3. Marucci DD, Cartmill JA, Walsh WR, Martin CJ. "Patterns of failure at the instrument-tissue interface." J Surg Res. 2000;93(1):16–20. doi:10.1006/jsre.2000.5906
4. Rodrigues SP, Horeman T, Dankelman J, van den Dobbelsteen JJ, Jansen FW. "Suturing intraabdominal organs: when do we cause tissue damage?" Surg Endosc. 2012;26(4):1005–9. doi:10.1007/s00464-011-1986-5
5. Cheng L, Hannaford B. "Evaluation of liver tissue damage and grasp stability using finite element analysis." Comput Methods Biomech Biomed Engin. 2016;19(1):31–40. doi:10.1080/10255842.2014.981166
6. van den Berg R, van Egmond S, Smits F, et al. "Small bites vs large bites for closure of abdominal midline incisions: a randomized clinical trial." JAMA Surg. 2026;161(6):566–73. doi:10.1001/jamasurg.2026.0618
7. Deerenberg EB, Henriksen NA, Antoniou GA, et al. "Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies." Br J Surg. 2022;109(12):1239–50. doi:10.1093/bjs/znac302
8. McHugh SM, Hill AD, Humphreys H. "Intraoperative technique as a factor in the prevention of surgical site infection." J Hosp Infect. 2011;78(1):1–4. doi:10.1016/j.jhin.2011.01.011
9. Chauveaux D. "Preventing surgical-site infections: measures other than antibiotics." Orthop Traumatol Surg Res. 2015;101(1 Suppl):S77–83. doi:10.1016/j.otsr.2014.07.028
10. Seidelman JL, Mantyh CR, Anderson DJ. "Surgical site infection prevention: a review." JAMA. 2023;329(3):244–52. doi:10.1001/jama.2022.24075
11. Teleflex Surgical Catalog. Bonney tissue forceps model 640524: 1×2 teeth, 3.3 mm tip, 6¾ inches; separate model 181327: 2×3 teeth. Manufacturer catalog.