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Army-Navy Retractor

Small, double-ended, lightweight handheld retractor for superficial wound retraction of skin, subcutaneous tissue, and superficial fascial layers — the first handheld retractor placed in the canonical Army-Navy → Richardson → Deaver progression. Not eponymously named — the instrument is named for the US Army and Navy Medical Corps that standardized it as part of mid-20th-century military surgical instrument sets, also called the "US retractor" in some catalogs.[1][2]

Design​

  • Double-ended: two blades of different sizes on opposite ends of a flat central handle; one slightly narrower / shorter and the other slightly wider / longer.
  • Blade shape: flat, slightly curved, tongue-shaped or spatula-shaped plate angled ~ 90–110° from the handle. Subtle concave curvature on the retraction surface cradles tissue and prevents slip.
  • Blade dimensions: narrow (~ 12–20 mm wide, ~ 20–35 mm deep), designed for shallow retraction.
  • Smooth atraumatic surface with rounded edges.
  • Length: typically 15–20 cm (6–8 in) overall.
  • Lightweight construction — thinner than Richardson or Deaver, reflecting its superficial-retraction role.
  • Material: surgical-grade stainless steel; the simple design is also amenable to 3D printing — a PLA Army-Navy retractor tolerated 13.6 kg of tangential force before failure at ~ $0.46 per unit in materials cost.[3]
  • No locking mechanism — handheld.

Reconstructive-Urology and Urogyn Uses​

The Army-Navy is the most-used handheld retractor in surgery, present on virtually every RU/urogyn tray. Daily applications:

Open abdominal and pelvic RU/urogyn​

  • Initial skin / subcutaneous retraction during the opening phase of every open laparotomy — midline, Pfannenstiel, Gibson, Cherney — for open BNR / augmentation / diversion / AUS / sacrocolpopexy / ureteral reimplantation.
  • Inguinal incisions — skin / subcutaneous retraction for inguinal orchidopexy / orchiectomy / hernia repair, groin-flap harvest (Singapore / pudendal-thigh).
  • Scrotal incisions — IPP / AUS scrotal pump-pouch exposure, hydrocelectomy, varicocelectomy, vasovasostomy at the skin / dartos layer.
  • Suprapubic incisions for SPC placement, pre-pubic AUS reservoir placement, small open BNR cases.

Perineal and external-genital RU/urogyn​

  • Perineal incisions — initial skin / subcutaneous retraction during posterior urethroplasty, perineal urethrostomy, transperineal RUF repair before the Turner-Warwick or Perineal Bookwalter takes over.
  • Vulvar / introital fine work — labiaplasty, vestibulectomy, Foldès clitoral reconstruction, post-defibulation closure.
  • Pediatric urology — hypospadias, orchidopexy, hydrocele / hernia, pediatric pyeloplasty where the smaller scaled-down field demands the smaller scaled-down retractor.

Adjunctive uses​

  • Wound exploration during traumatic genital-laceration repair, scrotal-abscess drainage, peri-stomal exploration.
  • Lymph-node biopsy for penile-cancer adjunctive sentinel-node / inguinal LND staging.
  • Minor procedures at the bedside or in clinic — incision-and-drainage of abscesses, foreign-body removal, biopsy.
  • Closure phase at the end of any open RU/urogyn case — re-positioned for skin / subcutaneous-layer closure after the deeper retractors are removed.

Robotic-adjunct and head/neck (when RU teams cross over)​

  • Skin-flap retraction in the rare cervical / submental cases that a reconstructive team participates in (e.g., free RFFF harvest with neck recipient vessels for phalloplasty).[4][5][6]

Military and austere settings​

  • Core component of military and field surgical-instrument sets — including the "Air Force Retractor" 3D-printed variant for expeditionary medicine in austere / anti-access environments.[7]

Army-Navy vs Richardson vs Deaver​

The three handheld retractors are complementary depths, not interchangeable:

RetractorDepthBlade
Army-NavySkin / subcutaneousNarrow flat angled, lightweight
RichardsonFascia / muscleWider shelf-like right-angle
DeaverDeep abdominal / pelvicLong curved ribbon

The progression: Army-Navy → Richardson → Deaver as the dissection moves from skin to deep abdomen.

Why the Lightweight Spatula Blade​

The Army-Navy's specific geometry suits the most superficial layer:

  • Atraumatic — broad smooth flat blade distributes force on delicate skin and subcutaneous edges; reduces ischemia and skin-edge necrosis.
  • Compact and lightweight — easy to hold for long periods; suitable for confined fields (neck, hand, perineum, scrotum) where larger retractors would be impractical.
  • Double-ended — quick adaptation between narrower / wider blades without instrument exchange.

3D Printing and Austere-Setting Innovation​

The Army-Navy retractor has become the proof-of-concept instrument for 3D-printed surgical tools. Rankin 2014 demonstrated that a PLA Army-Navy retractor printed by fused-deposition modeling:

  • Print time: ~ 90 minutes.
  • Weight: 16 g.
  • Material cost: ~ $0.46.
  • Tolerated 13.6 kg of tangential force before failure — well beyond operative demands.
  • Freshly extruded PLA from the printer in a clean environment was sterile and produced no bacterial product on PCR testing.[3]

The US Air Force has explored 3D printing of the same family of retractors (the "Air Force Retractor") for regenerating surgical supplies in austere anti-access / area-denial environments where standard supply chains may be disrupted.[7]

These innovations highlight the potential for on-demand instrument manufacturing in resource-limited settings, disaster zones, and military field hospitals — applications where the Army-Navy's simple design makes it the natural first candidate.

Comparison Within the Superficial-Retractor Family​

RetractorBladeBest fit
Army-NavyDouble-ended flat spatula angled, ~ 12–20 mm wideGeneral superficial wound retraction
SennDouble-ended: flat blade + 3-prong rakePlastic / hand surgery, very shallow
RagnellDouble-ended: two flat bladesPlastic / hand surgery, very shallow
US / ParkerDouble-ended, narrow angledSuperficial general wound retraction (similar to Army-Navy)
WeitlanerHinged self-retaining with sharp / blunt prongsHands-free shallow-to-moderate retraction
Adson-BeckmanSelf-retaining wedge with pronged bladesHands-free shallow-to-moderate wound retraction

Limitations​

  • Requires an assistant — fatigues; assistant hand-position shift produces inconsistent exposure. For hands-free retraction at this depth, switch to Adson-Beckman, Weitlaner, or Lone Star.
  • Shallow depth only — switch to Richardson or Deaver as the dissection deepens.
  • Limited retraction force — not for retracting heavy / thick tissue; not for obese-patient thick abdominal walls.
  • Narrow footprint — wider retractors more effective for broad retraction.
  • Skin-edge injury with excessive force or improper positioning — focal pressure on skin edges contributes to wound-edge necrosis under tension.

Technique​

  1. Gentle traction — minimum effective force; excessive force on skin edges causes ischemia and impairs wound healing.
  2. Moist gauze between blade and skin edge in long procedures.
  3. Match end to wound width — smaller blade for narrow wounds and delicate tissue; larger blade for wider wounds / thicker subcutaneous tissue.
  4. Full blade contact — insert the blade fully under the wound edge so the entire blade surface contacts tissue; avoid hooking only the tip.
  5. Transition promptly to Richardson / Deaver once deeper layers are exposed.

Origin and Current Status​

The Army-Navy is unique among surgical instruments in bearing an institutional rather than eponymous name.[1][2] Its history is rooted in the standardization of surgical instrument sets by the US military during the World War I / World War II era — the military medical services required instruments that were simple, robust, multipurpose, easy to mass-produce in stainless steel, and the Army-Navy embodies that brief perfectly. The Pepper 2026 transatlantic-instrumentation review identifies it as a characteristically American instrument; British surgeons use different retractors (Kilner cat's-paw, etc.) for equivalent tasks.[1]

The instrument remains one of the most fundamental and universally used tools in all of surgery — present on every laparotomy tray, every minor-procedure tray, every basic surgical instrument set worldwide.[1][2][3] Its enduring presence reflects the timeless value of simplicity in surgical instrument design.

See also: Richardson, Deaver, Adson-Beckman, Lone Star, Bookwalter.

References​

1. Pepper T, McMillan D, Jenzer A, et al. "Transatlantic tools of the trade: Anglo-American instrumentation in oral and maxillofacial surgery." Br J Oral Maxillofac Surg. 2026;64(3):223–33. doi:10.1016/j.bjoms.2025.12.006

2. 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.

3. Rankin TM, Giovinco NA, Cucher DJ, et al. "Three-dimensional printing surgical instruments: are we there yet?" J Surg Res. 2014;189(2):193–7. doi:10.1016/j.jss.2014.02.020

4. Prager G, Czerny C, Kurtaran A, et al. "Minimally invasive open parathyroidectomy in an endemic goiter area: a prospective study." Arch Surg. 2001;136(7):810–6. doi:10.1001/archsurg.136.7.810

5. Mohamed HE, Kandil E. "Robotic trans-axillary and retro-auricular thyroid surgery." J Surg Oncol. 2015;112(3):243–9. doi:10.1002/jso.23955

6. Byeon HK, Koh YW. "The new era of robotic neck surgery: the universal application of the retroauricular approach." J Surg Oncol. 2015;112(7):707–16. doi:10.1002/jso.24019

7. Chambers JA, Seastedt KP, Raymundo-Grinstead J. "An example of 3-D printing for expeditionary medicine: the Air Force Retractor." Mil Med. 2020;185(5–6):e565–7. doi:10.1093/milmed/usz449