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Volkmann (Rake) Retractor

Single-ended handheld rake retractor with multiple sharp or blunt prongs in a row at the end of a flat handle, the multi-prong retractor for retracting skin, subcutaneous tissue, muscle, and periosteum in deeper or wider fields than a Senn can manage. Named for Richard von Volkmann (1830–1889), one of the most influential surgeons of the 19th century, founding figure of orthopedic surgery, early adopter of Lister's antiseptic technique in Germany, and namesake of Volkmann's ischemic contracture and the Hueter-Volkmann law.[1]

Design​

  • Working end. Multiple prongs (tines) in a single row on a transverse bar, the "rake."
  • Prong-count variants. 1, 2, 3, 4, or 6 prongs. The 2-, 3-, and 4-prong versions are in daily use; 6-prong for the broadest exposure.
  • Sharp versus blunt prongs. Sharp for firm grip on skin, dense subcutaneous tissue or periosteum; blunt for muscle, fascia and near delicate structures.
  • Prongs curved slightly inward. Hook configuration prevents slip-out under traction.
  • Handle. Flat straight stainless-steel strip, approximately 20–22 cm (8–8.5 in) overall.
  • Single-ended (no smooth blade on the other end, which distinguishes Volkmann from Senn).
  • Material: surgical-grade stainless steel, autoclavable.
  • No locking. Handheld.

Reconstructive-Urology and Urogyn Uses​

The Volkmann rake fills the wider-than-Senn and shallower-than-Richardson niche on RU and urogyn trays, particularly useful when the field is broader than a single Senn can hold and a Richardson would be overkill:

  • Open inguinal incisions. Orchidopexy, hernia repair, groin-flap harvest (Singapore or pudendal-thigh), inguinal LND for penile-cancer staging.
  • Open scrotal incisions for IPP, AUS, hydrocelectomy or varicocelectomy when the field is wider than the Senn-Miller can hold, particularly large hydroceles, scrotal-skin flap-reconstruction cases, large-scrotal-mass excisions.
  • Vulvar or introital reconstruction. Broader retraction during labiaplasty, vestibulectomy, post-defibulation closure, vulvar-cancer-adjunct exposure (when scoped to reconstructive consequence).
  • Open pubectomy and pubic-ramus exposure during PFUI repair, with periosteal retraction at the inferior pubic ramus, paired with Langenbeck.
  • Open suprapubic incisions. At the skin or subcutaneous layer for SPC placement, AUS reservoir, small open BNR.
  • Perineal exposure during posterior urethroplasty before the Perineal Bookwalter (Jordan) or Turner-Warwick ring takes over, with handheld initial retraction across the perineum.
  • Closure phase of any open RU case, when the rake redeploys for the subcutaneous or skin closure layer.

Volkmann vs Senn vs Skin Hook​

FeatureVolkmannSenn (Senn-Miller)Skin hook
EndsSingle (rake only)Double (rake + smooth blade)Single (hook only)
Prongs1, 2, 3, 4, or 6Fixed 3Single or double
Length~ 20–22 cm~ 16 cm~ 16 cm
Field widthWiderSmallerSmallest, focal
Tissue gripDistributed across prongsDistributed across 3 prongsSingle-point focal
Best fitWider / deeper skin and superficial layersSmall-field skin / subcutaneousFine flap edges, delicate skin

The Volkmann is larger than the Senn; the Volkmann's prong-count flexibility lets the surgeon match the rake to the wound width.

Comparison to Adjacent Handheld Retractors​

RetractorTissue gripDepthBest fit
Volkmann (rake)Excellent (prongs engage tissue)Superficial-to-intermediateSkin / muscle / periosteum, wider fields
Senn (Senn-Miller)Excellent (rake) / moderate (blade)Superficial-to-intermediateSmaller skin / superficial-muscle fields
Army-NavyModerate (smooth)Skin / subcutaneousGeneral superficial wound retraction
RichardsonModerate (shelf-blade)Fascia / muscleAbdominal-wall layered retraction
DeaverLimited (smooth)Deep cavityDeep abdominal / pelvic

Mechanism​

  1. Prong engagement. Prongs placed into the wound edge; sharp penetrate for grip, blunt compress and hook.
  2. Lateral retraction: assistant pulls handle laterally to displace tissue; multiple prongs distribute force across a wider area than a single skin hook, reducing tearing.
  3. Sustained exposure: flat handle allows steady prolonged retraction with minimal fatigue.
  4. Adjustable depth and angle by varying prong-insertion depth and traction angle.

Limitations​

  • Handheld. Requires an assistant; fatigues; switch to self-retaining (Weitlaner, Adson-Beckman, Lone Star) for prolonged retraction.
  • Sharp-prong tissue trauma. Puncture, wound-edge ischemia, glove perforation, sharps-injury risk to surgical team. Blunt-prong variant mitigates.
  • Limited depth. Superficial-to-intermediate only; switch to Richardson or Deaver for deeper layers.
  • Single-ended. No smooth-blade alternative on the same instrument (versus Senn).
  • Not for delicate or fine flap edges. A single skin hook is preferable for facial, glanular or fine labial work.

Technique​

  1. Match prong number to wound width. 2-prong for narrow approaches (small orthopedic or pediatric inguinal); 3- or 4-prong for standard incisions; 6-prong for the widest exposures.
  2. Sharp versus blunt. Sharp for skin, dense subcutaneous tissue or periosteum; blunt for muscle, fascia and near nerves, vessels, ureter or dorsal NVB.
  3. Angle. Approximately 45–60° from tissue surface; too perpendicular pulls prongs out, too shallow loses effective depth.
  4. Minimize force: steady moderate traction; excessive force tears tissue and bends prongs.
  5. Minimize repositioning. Each removal-and-reinsertion produces additional trauma; plan placement carefully.
  6. Protect underlying structures: when using sharp prongs near nerve / vessel / ureter, ensure tips are directed away; otherwise switch to blunt.
  7. Transition to deeper retractors as the dissection progresses (rake, then Richardson, then Deaver or Bookwalter).

Historical Context — Richard von Volkmann​

Richard von Volkmann (1830–1889) was Head of Surgery at the University of Halle from 1867 until his death, and one of the giants of 19th-century surgery alongside Langenbeck, Esmarch, Lister, Billroth, Kocher, and Trendelenburg.[1]

  • Pioneer of orthopedic surgery and one of its founding figures.[1][10]
  • Lead surgeon for the German military during the Austro-Prussian War (1866) and Franco-Prussian War (1870–71); wartime mortality comparisons led him to investigate civilian-hospital hygiene and become one of the first surgeons in Germany to adopt Lister's antiseptic technique, and he was instrumental in introducing antisepsis to German surgical practice.[1][2][3]
  • Volkmann's ischemic contracture. Progressive post-traumatic muscle contracture from compartmental-space ischemic necrosis, most commonly the forearm flexor compartment after supracondylar humeral fractures. Remains a cornerstone concept in orthopedic and emergency medicine.[4][5][6][7]
  • Hueter-Volkmann law. Increased mechanical compression on a growth plate retards growth; decreased compression (tension) stimulates it. Foundational to understanding progressive skeletal deformities in children and the rationale for orthotic or surgical correction.[8][9]
  • Pioneer of oncologic surgery. Early excisions of rectal carcinoma are attributed to him.[10]
  • Children's literature. Under the pen name "Richard Leander" published widely loved German fairy tales and poems.[1]

See also: Senn, Army-Navy, Richardson, Langenbeck, Adson-Beckman, Lone Star.

References​

1. Willy C, Schneider P, Engelhardt M, Hargens AR, Mubarak SJ. "Richard von Volkmann: surgeon and Renaissance man." Clin Orthop Relat Res. 2008;466(2):500–6. doi:10.1007/s11999-007-0007-4

2. Alexander JW. "The contributions of infection control to a century of surgical progress." Ann Surg. 1985;201(4):423–8. doi:10.1097/00000658-198504000-00004

3. Nakayama DK. "Antisepsis and asepsis and how they shaped modern surgery." Am Surg. 2018;84(6):766–71.

4. Raimer L, McCarthy RA, Raimer D, Colome-Grimmer M. "Congenital Volkmann ischemic contracture: a case report." Pediatr Dermatol. 2008;25(3):352–4. doi:10.1111/j.1525-1470.2008.00681.x

5. Broadhurst PK, Robinson LR. "Compartment syndrome: neuromuscular complications and electrodiagnosis." Muscle Nerve. 2020;62(3):300–8. doi:10.1002/mus.26807

6. Ozer K. "Nerve lesions in Volkmann ischemic contracture." J Hand Surg. 2020;45(8):746–57. doi:10.1016/j.jhsa.2020.03.027

7. Pettitt DA, McArthur P. "Clinical review: Volkmann's ischaemic contracture." Eur J Trauma Emerg Surg. 2012;38(2):129–37. doi:10.1007/s00068-011-0079-4

8. van Gelein Vitringa VM, van Royen BJ, van der Sluijs JA. "Scapular deformity in obstetric brachial plexus palsy and the Hueter-Volkmann law; a retrospective study." BMC Musculoskelet Disord. 2013;14:107. doi:10.1186/1471-2474-14-107

9. Culik J, Marik I, Cerny EP. "Biomechanics of leg deformity treatment." J Musculoskelet Neuronal Interact. 2008;8(1):58–63.

10. Hernigou P. "Authorities and foundation of the orthopaedic school in Germany in the 19th century: part II — Richard von Volkmann, Julius Wolff, Albert Hoffa, Friedrich Trendelenburg and other German authors." Int Orthop. 2016;40(4):843–53. doi:10.1007/s00264-015-3051-9