Pin Tract Release Incision Using Mini Gelpi Retractors 

Submitted by James P. Toombs, DVM, Diplomate ACVS | Iowa State University, Ames Iowas

Gelpi retractor holding a release incision open during an external fixation fracture repair
Image courtesy of James P. Toombs, DVM, Diplomate ACVS | Iowa State University

In the early days of using smooth pins with external skeletal fixation, minimal, if any soft tissue release was recommended. Since threaded fixation pins have become the standard, most authors and teachers recommend utilizing a drill sleeve to prevent tissue trauma. Unfortunately, the drill sleeve has become a method to atraumatically create an undersized soft tissue tunnel. The minimum release incision size should be that which yields no soft tissue tension on the pin at any point during full flexion and extension of the joints above and below the fixator pins.

Once clinicians appreciate large release incisions, they often find themselves increasing the incision after pin placement. In reality, they should initially consider using a larger incision and miniature gelpi retractor to hold the soft tissue release open during pin placement.

Advantages of retracted liberal release incisions:

• Reduced patient morbidity during healing
• Clear visibility insures accurate pin placement
• Enhanced soft tissue protection
• Frees hands for other tasks
• No more "How do I find the pre-drilled hole?"

In short, the mini gelpi retractor should be a part of every ESF pack since it will greatly simplify application of ESF frames.