Bibliographic record
Abstract
Sir: Adequate operative exposure is important during pediatric hand surgery, which demands precise exposure in a small surgical field. A good retractor must be safe, simple, and easy to use, providing adequate retraction and a wide field of view.1,2 Self-retaining retractors are preferable to conventional retractors because they free up assistants and reduce the number of hands crowding the operative area. Arem described a self-retaining retractor for use in hand surgery consisting of weights applied to stay sutures.3 Although preferable to handheld retractors, this is difficult to reposition and cannot easily provide tension in multiple directions. Pearl et al. described a self-retaining retractor consisting of stay sutures fixed through cuts in the rim of a plastic bowl.2 This provides disposable and inexpensive exposure; however, creation and assembly is cumbersome, and the inflexible ring limits intraoperative repositioning. The ideal self-retaining retractor would provide good exposure, gentle yet adequate tension, and easy and quick repositioning of each digit individually in multiple planes. The Lone Star retraction system (Cooper Surgical), consisting of elastic stay hooks positioned by means of slots on the periphery of a disposable adjustable plastic ring frame, is a relatively inexpensive (approximately CaD $200)4 yet extremely effective self-retaining retractor for use during pediatric hand surgery. The sterile disposable Lone Star retractor consists of a hinged frame and hooks attached to elastic stays (Fig. 1). After the patient is prepared and draped, 2-0 silk stay sutures are placed through the nail plate and pulp of each digit and tied in a deliberately loose loop. One limb of the frame is secured with towel clips to the surgical drapes in the vicinity of the hand. The other limb is positioned upright, and the hinge between the two limbs is tightened. The hook of each elastic stay is placed through one of the previously placed loops in each finger and is then anchored on the frame. The elastic stays and the hooks are repositioned as necessary during the stages of the procedure (Fig. 2). On completion, the frame and stays may be left in place to facilitate application of a dressing, after which the stays and silk sutures are removed.Fig. 1.: The components of the Lone Star retractor include the hinged and slotted frame and the elastic stays with attached hooks. Also shown are 2-0 silk stay suture loops in the nail plate and pulp of the digits. Towel clips are used to secure the retractor frame to the arm board.Fig. 2.: The Lone Star disposable plastic ring is positioned using the adjustable hinges and secured using towel clips. The hook on each elastic stay is placed through the suture loop on the selected finger. The elastic stay is in turn anchored in the appropriate slot on the frame.The Lone Star retraction system has previously been described as an effective way of obtaining complete eversion of prolapsed hemorrhoids.4 Several features make this an appealing self-retaining retractor for use during pediatric hand surgery. First, the hinged frame with multiple slots for the stays provides the surgeon with many options in three-dimensional positioning of individual digits. Second, the long elastic stays keep the surgical site remote from the frame and allow the digits to remain stable in any position and to avoid excessive tension. Finally, the combination of hooks on the stays and suture loops on the digits facilitates quick repositioning. Because it is adjustable, disposable, quick to assemble, and easy to use, we believe that the Lone Star retraction system provides a versatile and superior alternative to conventional handheld or self-retaining retractors used during pediatric hand surgery. DISCLOSURE Neither author has any commercial associations or financial disclosures to declare. Aaron Knox, M.D. Division of Plastic Surgery University of British Columbia Vancouver General Hospital Vancouver, British Columbia A. Robertson Harrop, F.R.C.S.C. Division of Plastic Surgery Department of Surgery Alberta Children's Hospital Calgary, Alberta, Canada
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".