Adson Tissue Forceps
Fine, short, spring-action thumb forceps — the workhorse skin- and superficial-tissue forceps for nearly every reconstructive-urology and urogynecology closure. Available in toothed (1×2), smooth-serrated, and Adson-Brown (7×7 fine teeth) variants; the toothed Adson is the default instrument in the hand of the closing surgeon during scrotal, penile-shaft-skin, perineal, suprapubic, vaginal-introital, and laparotomy-incision closure.[1]
Design
- Length: ~ 12 cm (4.75 in) — short enough for fine bimanual skin work, too short for deep pelvic exposure.
- Profile: wide flat thumb grip tapering to narrow, finely tapered tips.
- Mechanism: spring-action thumb forceps; the two arms are joined proximally and held open by the metal's spring.
- Material: surgical-grade stainless steel, autoclavable; disposable variants also widely available.
Working-Surface Variants
| Variant | Working surface | Best tissue |
|---|---|---|
| Adson-toothed (1×2) | Single tooth interlocking between two opposing teeth | Skin edges, dartos, fascia during closure |
| Adson smooth-serrated | Fine transverse serrations, no teeth | Subcutaneous tissue, small vessels, nerves, fragile mucosa |
| Adson-Brown (7×7) | Multiple fine interlocking teeth across a wider platform | Plastic / reconstructive skin handling where 1×2 teeth slip |
| Double-ended Adson | Toothed jaws on one end, smooth on the other | Hand and head-and-neck cases requiring frequent switching[2] |
The Toothed-vs-Smooth Trade-Off
The toothed Adson is the preferred forceps for skin because the interlocking teeth grip dermis securely at low squeeze pressure — minimizing the crush injury that would otherwise be required to hold skin with a smooth tip. The smooth-serrated Adson reverses the trade-off: gentler on delicate internal tissue (vessel, nerve, vasal mucosa, ureteral mucosa) but prone to slippage on skin, which prompts the surgeon to compensate with greater squeeze and paradoxically deliver more trauma. This is the same instrument–tissue interface principle that governs forceps selection across the tray: increase tooth size for grip on tough tissue, decrease tooth size or remove teeth entirely for fragile tissue.
The Adson-Brown variant sits between the toothed Adson and a smooth tip — its 7×7 fine teeth distribute compressive force across a wider platform, which is why it is favored for plastic-surgery skin handling and for thin or sun-damaged skin (often relevant in geriatric urogynecology closures).
Technique
- Grip: pencil grip between thumb and index, stabilized by the middle finger.
- Match the variant to the tissue layer, not to the step of the operation: toothed for skin and fascia; smooth-serrated for subcutaneous fat, vessels, nerves, urethral or ureteral mucosa.
- Brief, focal grasp: the goal is to evert and present the wound edge for needle passage, not to crush it. Repeated regripping at the same point compounds focal trauma.
- For dermal skin closure, the toothed Adson is paired with a fine needle driver and a monofilament suture; the Custis 2015 RCT found no improvement in 3-month cosmesis when adhesive strips were added over dermal sutures alone, supporting a streamlined "good dermal closure + Adson" approach for routine reconstructive incisions.[3]
Reconstructive-Urology and Urogyn Uses
- Scrotal and penile-shaft-skin closure after hydrocelectomy, varicocelectomy, vasectomy / vasovasostomy, IPP and AUS scrotal incisions, penile-prosthesis exposure, and skin-bridge revision.
- Suprapubic skin closure for open BNR, augmentation, diversion, and AUS abdominal pouch incisions.
- Vaginal introital and perineal closure for prolapse repair, perineorrhaphy, fistula repair, episiotomy-defect revision, and post-defibulation closure.
- Inguinal incisions for groin-flap harvest, lymph-node dissection, and orchiopexy.
- Microsurgical setup: the smooth-serrated Adson is sometimes used as a backup to Gerald for adventitial handling during vasovasostomy and microsurgical varicocelectomy when finer forceps are unavailable; for true microsurgical layers (vasal mucosa, epididymal tubule), Gerald or Castroviejo is preferred.
Distinctions from Adjacent Forceps
| Forceps | Profile vs Adson | Best layer |
|---|---|---|
| Adson (this page) | Short, fine, 1×2 teeth or smooth-serrated | Skin, dartos, subcutaneous tissue |
| Gerald | Longer, narrower, finer; microsurgical | Vasal / epididymal / ureteral mucosa, tunica |
| DeBakey | Longer, atraumatic, parallel ridged platform | Vessels, ureter, bowel serosa |
| Bonney | Heavier, larger, 1×2 deep teeth | Rectus fascia, abdominal wall, dense scar |
| Russian | Concentric serrated cup tips, no teeth | Atraumatic handling of bulkier tissues |
| Singley | Long, fenestrated, ring-handled | Bowel, packing |
Historical Context
Named for Alfred Washington Adson (1887–1951), the first chair of the Section of Neurological Surgery at the Mayo Clinic and one of the founders of American neurosurgery. Adson described operations across spinal-cord tumors, peripheral nerve, and cerebrovascular disease, designed multiple instruments still in daily use, and lent his name to both the Adson test for thoracic outlet syndrome and the Adson-Brown forceps.[1]
See also: Gerald, DeBakey, Bonney, Russian.
References
1. Griessenauer CJ, Tubbs RS, Shoja MM, et al. "Alfred W. Adson (1887–1951): his contributions to surgery for tumors of the spine and spinal cord in the context of spinal tumor surgery in the late 19th and early 20th centuries." J Neurosurg Spine. 2013;19(6):750–8. doi:10.3171/2013.9.SPINE13220
2. Tegtmeier RE. "A double-ended Adson-type forceps." Ann Plast Surg. 1979;2(4):352.
3. Custis T, Armstrong AW, King TH, Sharon VR, Eisen DB. "Effect of adhesive strips and dermal sutures vs dermal sutures only on wound closure: a randomized clinical trial." JAMA Dermatol. 2015;151(8):862–7. doi:10.1001/jamadermatol.2015.0174