Army-Navy Retractor
The Army-Navy is a small, double-ended handheld retractor used to lift wound edges and expose superficial tissue. Its flat angled blades provide an alternative to hooks or toothed rake retractors when a smooth blade is useful. It is a practical instrument for opening and closing small incisions, even when a larger retractor will be used for the deeper part of the operation.
Design and size selection
The two ends have different working profiles, allowing the assistant to change the exposure without exchanging instruments. The central handle is held manually; there is no locking frame. The instrument name describes a pattern, not a single standardized size. For example, Teleflex lists the Pilling 164715 with a 1.5 cm blade width and 21.5 cm overall length, supplied as a set of two.[1]
Choose the working end by the actual wound and the tissue being displaced. A blade that is too short can catch only the wound margin; an unnecessarily large blade can obstruct a small field. Check the instrument supplied on the local tray rather than relying on the name alone.
Reconstructive-urology applications
Common practical uses include:
- Perineal exposure: retracting skin and subcutaneous edges at the beginning of urethroplasty, before deeper exposure with a Turner-Warwick or perineal Bookwalter.
- Scrotal and inguinal incisions: assisting exposure during pump-pocket work, hydrocele surgery, or inguinal procedures when the blade fits the wound.
- Small suprapubic incisions: superficial exposure before entering the deeper operative plane.
- Wound closure: lifting an edge to see the layer being sutured after larger retractors have been removed.
- Open pelvic and abdominal cases: skin and subcutaneous retraction while opening a midline, Pfannenstiel or Gibson incision for augmentation, diversion, AUS reservoir placement, sacrocolpopexy or ureteral reimplantation.
- Groin-flap harvest and inguinal exposure: skin and subcutaneous retraction for orchidopexy, orchiectomy, hernia repair or Singapore and pudendal-thigh flap harvest.
- Vulvar and introital work: labiaplasty, vestibulectomy and clitoral reconstruction, where the small blade suits a confined field.
- Pediatric urology: hypospadias, orchidopexy, hernia and pyeloplasty, where a scaled-down field calls for a smaller retractor.
- Bedside and clinic procedures: wound exploration after genital laceration, abscess drainage, peristomal exploration and foreign-body removal.
These are conventional uses. No comparative study shows an Army-Navy improves outcomes over another suitable retractor.
Practical handling
- Ask the surgeon which edge and direction of traction will open the intended plane.
- Place the selected blade under direct vision, supporting tissue on the blade surface rather than catching a small point with its tip.
- Apply the least traction that maintains the view. Keep the assistant's hand and opposite blade clear of the working instruments.
- Reposition as the dissection moves. Increasing force on a shallow blade is usually less useful than changing its position or selecting a deeper instrument.
- Relax traction when exposure is no longer needed, and inspect compressed tissue during a prolonged case.
Choosing an adjacent instrument
| Exposure requirement | Useful instrument pattern |
|---|---|
| Superficial wound edge | Army-Navy or Senn |
| Deeper wall or muscle edge | Richardson or Langenbeck, according to blade dimensions |
| Deep curved abdominal exposure | Deaver |
| Sustained exposure without a continuously held blade | An appropriately sized self-retaining system |
The familiar Army-Navy–Richardson–Deaver sequence is a teaching aid about blade reach, not a mandatory sequence. Smooth metal can still cause pressure injury. The required blade, traction and reassessment depend on the tissue and operation.
Limitations
- It needs a held hand. The assistant fatigues, and a shifting hand position changes the exposure. For hands-free retraction at this depth, use an Adson-Beckman, a Weitlaner or a Lone Star.
- Shallow reach. Change to a Richardson or Deaver as the dissection deepens.
- Limited force. It is a poor choice for thick abdominal walls or heavy tissue.
- Skin-edge injury. Sustained focal pressure can devascularize the wound edge. Use the least traction that holds the view, and place moist gauze between blade and skin in long cases.
Comparison within the superficial-retractor family
| Retractor | Blade | Best fit |
|---|---|---|
| Army-Navy | Double-ended flat angled blade | General superficial wound retraction |
| Senn | Double-ended: flat blade and three-prong rake | Plastic and hand surgery, very shallow fields |
| Weitlaner | Hinged self-retaining, sharp or blunt prongs | Hands-free shallow-to-moderate retraction |
| Adson-Beckman | Hinged self-retaining, multiprong blades | Hands-free retraction of deeper soft tissue |
3D-printed and austere-setting versions
The Army-Navy is the instrument most often used to test 3D-printed surgical tools. Rankin and colleagues printed a polylactic-acid copy by fused deposition modeling. Printing took about 90 minutes, the copy weighed 16 g and used about $0.46 of filament. It tolerated 13.6 kg of tangential force before failure, before and after glutaraldehyde sterilization. Freshly extruded filament produced no bacterial PCR product.[2] The authors estimated the cost at about one tenth of a stainless-steel instrument. The US Air Force has described a 3D-printed "Air Force Retractor" as a proof of concept for regenerating supplies in austere settings. It is a prototype, not a validated clinical device.[3]
Naming
The name describes a US pattern rather than an eponym. A 2026 UK and US comparison of oral and maxillofacial instrument sets lists the Army-Navy among US instruments that have functionally equivalent but non-identical British counterparts.[4]
References
1. Teleflex/Pilling. Army-Navy Retractor, catalog 164715. Manufacturer product specifications.
2. 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
3. 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-e567. doi:10.1093/milmed/usz449
4. 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):223-233. doi:10.1016/j.bjoms.2025.12.006