Abstract:
A surgical retractor is provided to retain tissue in a retracted position and expose an interior surface during a surgical procedure. The surgical retractor is self-retaining and includes opposing blades that are removably mountable on arms of the surgical retractor via a ball-and-socket assembly that permits swiveling and hinging of the opposing blades independent from each other and the arms. Each of the opposing blades have a plurality of talons with a curved surface to slidably receive and partially enwrap bone matter so that the plurality of talons securely engage the bone matter while permitting slidable adjustment therebetween.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This patent application claims priority to U.S. patent application Ser. No. 29/376,374 filed Oct. 6, 2010, the entire contents of which is herein incorporated by reference in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The present general inventive concept relates generally to medical instruments, and more particularly, to a surgical retractor to retain tissue in a retracted position and expose an interior surface during a surgical procedure. 
         [0004]    2. Description of the Related Art 
         [0005]    A retractor is a surgical instrument that allows a surgeon to separate edges of a surgical incision or wound. Conventional retractors generally encompass a handheld tool having a narrow blade that can be used to separate tissue and hold the tissue in a retracted state so that a surgical site is exposed. The narrow blade is typically affixed to a single arm or a narrow blade on a pair of linked pivoting arms. 
         [0006]    Conventional retractors generally require a surgeon to maintain the tissue in the retracted state substantially throughout an entire surgical procedure. During the course of the surgical procedure, it is likely that the blade of the retractor will lose its grip on the tissue (e.g., due to the slippery nature of tissue), and that the inadvertent movement of the retractor (e.g., due to movement of the patient or the surgeon) will cause the retractor to deviate from the surgical site. Additionally, during the course of the surgical procedure, it is possible that the surgeon may desire a different perspective of the surgical site. 
         [0007]    Such slips and movement, whether inadvertent or advertent, lengthen the time period required of the surgical procedure, which increases trauma to the patient thus extending recover time of the patient from the surgical procedure, elevates the risks associated with the surgical procedure, and increases the costs of the surgical procedure. 
         [0008]    One such conventional retractor-type device is disclosed in U.S. Pat. No. 5,931,777 to Sava, the entire contents of which is herein incorporated by reference in its entirety. Sava provides a complex device that penetrates bone matter of a patient in order to maintain its position in the patient once established by a surgeon which is undesirable for two reasons. First, it is undesirable to make an incision or otherwise damage any part of the patient via penetrating or the like as such necessarily increases trauma and recovery time. In fact, intentional damage to a patient caused by a surgeon is typically only done only out of necessity. Second, very few surgeries include bone matter adjacent to a surgical field that would permit use of the Sava device as disclosed. In fact, the Sava device is only illustrated in use during spinal surgery. 
         [0009]    Thus, there is a need for a retractor that does not suffer from the limitations of conventional retractors, is versatile to permit use in a wide variety of applications, has a simple design that is easy to use, and does not prolong recovery time or expenses of the patient. 
       SUMMARY OF THE INVENTION 
       [0010]    A principal object of the present general inventive concept is to provide a retractor that remedies the aforementioned deficiencies in conventional retractors and is ideal for retracting tissue during treatment of any tubular bone fracture including but not limited to the radius, ulna, femur, humerus, fibula, and clavicle. 
         [0011]    Another object of the general inventive concept is to provide a retractor having a plurality of blades that are operable to retain tissue at a surgical site of a patient in a retracted position by leveraging on a portion of the patient at or adjacent to the surgical site so that the surgical site is exposed throughout the course of a surgical procedure. The surgical retractor is self-retaining and includes the plurality of blades are removably mountable on arms of the surgical retractor via a ball-and-socket assembly that permits swiveling and hinging of the opposing blades independent from each other and the arms, i.e., movement of each blade relative to the arms along up to three axes, e.g., an X, Y, and/or Z axes, or along up to three different planes. 
         [0012]    Another object of the general inventive concept is to provide a retractor that is operable to slidably lever on a portion of a surgical site (e.g., a bone) during movement of the retractor from a first configuration (e.g., a stored configuration), to a second configuration (e.g., an in-use configuration) so that tissue is retracted from the surgical site and the surgical site is maximally exposed and subsequent adjustment of the retractor is facilitated via the slidable levering of the retractor. 
         [0013]    Another object of the general inventive concept is to provide a retractor having a blade with edge portions and a talon that cooperatively form a cavity at a center of the blade. 
         [0014]    Another object of the general inventive concept is to provide a retractor for use at a surgical site. The retractor has a tissue-contact portion and a surgical-site contact portion. The tissue-contact portion is of a first size and shape to maximize contact of the retractor with the tissue while conforming to an opening at the surgical site. The surgical-site contact portion is of a second size and shape to minimize contact of the retractor with the surgical site. 
         [0015]    Another object of the general inventive concept is to provide a retractor having a universal coupler that is sized and shaped to connect with blades of different shapes and/or sizes to enable the retractor to adapt to various applications of the retractor. For instance, the present invention is operable to permit substitution of a first blade with a second blade of relatively longer length to enable use of the retractor in applications requiring deeper insertion into areas with thicker and/or deeper soft tissue. 
         [0016]    Another object of the general inventive concept is to provide a retractor and method of use that is easy to use, comparatively simple to manufacture, and especially well adapted for the intended usage thereof. 
         [0017]    The aforementioned objects and advantages of the present general inventive concept may be achieved by providing a self-retaining retractor assembly including an elongated body having opposing arms that are hinged together at a connection point that is spaced from either end of the elongated body. The spacer may be coupled to and depend from each of the arms. Each of the spacers may have a plurality of axes and be operable to independently pivot with respect to the elongated body about each of the plurality of axes. The spacer may be operable to partially enwrap a portion of a surgical site. 
         [0018]    The self-retaining retractor assembly may further include a coupling assembly operable to permit independent removal of one or both spacers from the arms. The coupling assembly may be a ball-and-socket coupling assembly having a ball depending from each of the arms that may be operable to be received via a snap-fit into an aperture in each of the spacers. The aperture may be defined by a circumferential wall having a degree of resiliency. The coupling assembly may provide each of the spacer with a first degree of pivot about the X and Z axes, and a second degree of pivot about the Y axis. The first degree of pivot may be defined by an annular ring on each of the arms. Each of the annular rings may limit the first degree of pivot of each of the spacers to about 45 degrees. The second degree of pivot may be perpetual or 360 degrees. The plurality of axes of each the spacers may intersect at the coupling assembly of each of the spacers. Each of the spacers may include a face surface with side edge portions and a bottom edge portion. The bottom edge portion may have at least one tooth or talon depending therefrom, or may have two, three or more talons of equal size and/or shape, or different size and/or shape depending therefrom. The side edge portion and the at least one talon may be concave to form a cavity on each of the face surfaces. 
         [0019]    The spacer may include at least one talon having a curved surface that may be operable to partially enwrap the portion of the surgical site. The spacer may include two talons each having a curved surface that each may be operable to cooperatively pivot and/or align the spacer with respect to the elongated body when the curved surfaces abut the portion of the surgical site. The talons may be slidable along the portion of the surgical site anytime during use of the self-retaining retractor. The self-retaining retractor does not penetrate any part of a patient (e.g., bone matter). The spacer may include two parallel curved talons with a curved wall extending perpendicular from either side of the two talons to collectively form and surround a cavity between the talons and walls. 
         [0020]    The self-retaining retractor assembly may further include a gripping element on one end of the elongated body having a plurality of finger holes. The self-retaining retractor assembly may further include a locking mechanism on the body that is operable to lock the arms in one of a plurality of orientations with respect to each other. The self-retaining retractor assembly may further include a spring on the locking mechanism that is operable to bias the locking mechanism to a locked configuration. The spacers may be radiolucent blades. The connection point may be a hinge that is operable to permit movement of at least one of the arms with respect to the other of the arms. 
         [0021]    The aforementioned objects and advantages of the present general inventive concept may further be achieved by providing a surgical retractor including a plurality of arms that may be hinged together, and a blade coupled to each of the arms via a friction-fit engagement. The present general inventive concept may include a divider between each of the plurality of arms and each of the blades that may be operable to define a limited range of movement the blade and the arm, and/or separate or at least facilitate separation of the blade from the arm if the blade exceeds the limited range of movement in any one of a plurality of directions. The limited range of movement provided to each of the blades may include a plurality of axes. The plurality of axes may include any one or combination of an X axis, a Y axis, and a Z axis. The plurality of axes may have an intersection point on the blade. 
         [0022]    The aforementioned objects and advantages of the present general inventive concept may further be achieved by providing a method of surgery including the steps of providing a retractor having a plurality of opposing blades depending from hinged arms that are operable to selectively define a void between the plurality of blades, setting the hinged arms in a first configuration with respect to each other, the first configuration defining a first plurality of axes of each of the plurality of blades and permitting independent movement of the plurality of blades along the first plurality of axes, inserting the plurality of blades at least partially into a surgical area with the hinged arms in the first configuration, partially enwrapping a portion of the surgical site via the spacer, and retracting an object or tissue adjacent to the surgical area by moving the hinged arms from the first configuration to a second configuration. 
         [0023]    The second configuration may define a second plurality of axes of each of the plurality of blades and permit independent movement of the plurality of blades along the second plurality of axes. The first and second plurality of axes may each include an X axis, a Y axis, and a Z axis. The X, Y and Z axes may share a common intersection point on the blade. 
         [0024]    The blades may be removable from the arms and may be a set of blades selected from a plurality of blades having different shapes and sizes, and the set of blades may be of equal size and/or shape or different size and/or shape. 
         [0025]    The method may further include the step of pivoting the spacer with respect to the elongated body when the portion of the spacer partially abuts and/or enwraps the portion of the surgical site. The portion of the spacer may be one talon or two talons that may have a curved surface to receive the portion of the surgical site. The curved surface may be contoured with respect to the portion of the surgical site. The portion of the surgical site may be a bone. 
         [0026]    The method may further include the step of levering a portion of the blades on a portion of the surgical area as the hinged arms are moved from the first configuration to the second configuration. The method may further include the step of slidable moving the portion of the blades along the portion of the surgical site after the hinged arms are moved to the second configuration. 
         [0027]    The foregoing and other objects are intended to be illustrative of the present general inventive concept and are not meant in a limiting sense. Many possible embodiments of the present general inventive concept may be made and will be readily evident upon a study of the following specification and accompanying drawings comprising a part thereof. Various features and subcombinations of present general inventive concept may be employed without reference to other features and subcombinations. Other objects and advantages of this present general inventive concept will become apparent from the following description taken in connection with the accompanying drawings, wherein is set forth by way of illustration and example, an embodiment of this present general inventive concept and various features thereof. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0028]    A preferred embodiment of the invention, illustrative of the best mode in which the applicant has contemplated applying the principles, is set forth in the following description and is shown in the drawings. 
           [0029]      FIG. 1  is a perspective view of a retractor in accordance with an exemplary embodiment of the present inventive concept, illustrating the retractor having a plurality of blades connected to arms of the retractor; 
           [0030]      FIG. 2  is a top plan view of the retractor illustrated in  FIG. 1 ; 
           [0031]      FIG. 3  is an elevated side view of the retractor illustrated in  FIG. 1 ; 
           [0032]      FIG. 4  is a magnified perspective view of the blades and the arms of the retractor illustrated in  FIG. 1  with one of the blades exploded from one of the arms; 
           [0033]      FIG. 5  is an elevated rear view of one of the blades illustrated in  FIG. 1 ; 
           [0034]      FIG. 6  is an elevated side view of one of the blades illustrated in  FIG. 1 ; 
           [0035]      FIG. 7  is a top-plan view of one of the blades illustrated in  FIG. 1 ; 
           [0036]      FIG. 8  is a perspective view of the retractor illustrated in  FIG. 1 , illustrating the retractor in use with the blades levered against a bone in a first configuration; and 
           [0037]      FIG. 9  is a perspective view of the retractor illustrated in  FIG. 1 , illustrating the retractor in use with the blades levered against a bone in a second configuration. 
       
    
    
       [0038]    The drawing figures do not limit the present inventive concept to the specific embodiments disclosed and described herein. The drawings are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the illustrated embodiment. 
       DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0039]    The present inventive concept is susceptible of embodiment in many forms. While the drawings illustrate, and the specification describes, certain embodiments of the invention, it is to be understood that such disclosure is by way of example only. The principles of the present inventive concept are not limited to the particular disclosed embodiments. 
         [0040]    With initial reference to  FIG. 1 , a surgical retractor  10  in accordance with the exemplary embodiment of the present inventive concept is illustrated. The retractor  10  has an elongated body  12  that is formed from stainless steel or like material. The elongated body  12  includes opposing arms  14 ,  16  at a distal end  18  thereof. The opposing arms  14 ,  16 , that are pivotably secured at a connection point or hinge  20  on the elongated body  12 . The hinge  18  is spaced from either end of the elongated body  12  and is operable to permit movement of one or both of the opposing arms  14 ,  16  relative to one another. In this manner, the opposing arms  14 ,  16  may be selectively distanced from each other in various configurations so that a void  22  between the opposing arms  14 ,  16  is thereby defined. A size of the void  22  is variably and selectively determined by the configuration of the opposing arms  14 ,  16 . 
         [0041]    On a side of the hinge  20  opposite to the opposing arms  14 ,  16 , i.e., at a proximal end  24  of the elongated body  12 , is a grip assembly  26 . The grip assembly  26  includes opposing extensions  28 ,  30  that are respectively connected to opposing arms  14 ,  16 . Each of the opposing extensions  28 ,  30  include an aperture  32  defined by a generally circumferential edge  34  of each of the opposing extensions  28 ,  30 . Each aperture  32  is sized and shaped to receive finger(s) and/or thumb(s) of a user or surgeon therethrough to facilitate use and manipulation of the retractor  10  by the surgeon. For purposes herein, the distal end  18  of the retractor  10  or any part thereof is the end closest to a surgical site and distant from the surgeon, while the proximal end  24  the retractor  10  is the end most proximate the surgeon and distant the surgical site. 
         [0042]    Similar to the operation of the opposing arms  14 ,  16 , the hinge  18  is operable to permit movement of one or both of the opposing extensions  28 ,  30  relative to one another. In this manner, the opposing extensions  28 ,  30  may be selectively distanced from each other in various configurations so that a void  36  between the opposing extensions  28 ,  30  is thereby defined. Similar to void  22  of the opposing arms  14 ,  16 , the size of the void  36  is variable and selectively determined by the configuration of the opposing extensions  28 ,  30 . 
         [0043]    A locking assembly  38  that is operable to lock the body  12  in a desired configuration is mounted to the grip assembly  26 . The locking assembly  38  includes a lever  40 , a tab  42 , and a spring  44 . The lever  40  is secured to the extension  30  and is biased into a locked configuration via the spring  44 . The tab  42  is secured to the extension  28  and slidably extends through aperture  46  in the extension  30 . The tab  42  has a plurality of notches  48  along an edge  46  of the tab  38  that are each sized and shaped to partially receive a point  50  that projects from the lever  40 . 
         [0044]    The spring  44  provides a degree of resiliency to the lever  40  so that the point  50  may be selectively pivoted from the locked configuration if the surgeon exerts a force on the lever  40  and automatically returns to the locked configuration if the surgeon releases the lever  40 . When in the unlocked configuration, the tab  42  is slidable within the aperture  46  and the opposing extensions  28 ,  30  and opposing arms  14 ,  16  may be moved relative to each other. Conversely, when in the locked configuration, the tab  42  is not slidable within the aperture  46  and the opposing extensions  28 ,  30  and opposing arms  14 ,  16  may not be moved relative to each other 
         [0045]    Turning now to  FIGS. 4-7 , a set of opposing blades  52 ,  54  are illustrated. The opposing blades  52 ,  54  are removably attached to each of the opposing arms  14 ,  16 , respectively, at the distal end  18  of the retractor  10 . In the exemplary embodiment, the blades  52 ,  54  are of a uniform thickness and each has parallel front and rear surfaces  58 ,  60  with a planar face  56  portion in a center thereof. About a perimeter of the front and rear surfaces  58 ,  60  are parallel side edges  62 ,  64  that are connected by parallel top and bottom edges  66 ,  68 . Extending from either end of each face  56  of the blades  52 ,  54  is an edge portion  70  with a degree of curvature relative to the face  56  in a range of 30-60 degrees and preferably 45 degrees from the face  56 . 
         [0046]    In the exemplary embodiment, the blades  52 ,  54  are of equal size and shape. It is foreseen, however, that the blades  52 ,  54  may be of different sizes and/or shapes to enable the retractor  10  to adapt to various applications without deviating from the scope of the present inventive concept. For instance, the degree of curvature of the edge portions  70  may be smaller (e.g., 0 degrees from the face  56 ), larger (e.g., 90 degrees from the face  56 ), and/or differ from each other. 
         [0047]    Depending from the bottom edge  68  of each of the opposing blades  52 ,  54  are a plurality of talons  72 . Each of the plurality of talons  72  has a curved body  74  having a degree of curvature that is substantially similar to the degree of curvature of the edge portions  70  extending from the face  56 . At a distal end of the curved body  74  is a point  76 , which is caused to be oriented substantially parallel to the side edges  62 ,  64  and the front surface  58  via the curved body  74 . In the exemplary embodiment, the point  76  is sufficiently dull so as to not damage any part of the patient during use of the present invention. 
         [0048]    The curvatures of the edge portions  70  extending from the face  56  and the plurality of talons  72  cooperatively cause the face  56  to be relatively depressed therebetween so that the face  56  is a cavity operable to securely receive a part of the patient therein. Additionally, the curvatures of the edge portions  70  extending from the face  56  are configured to maximize a contact area between the blades  52 ,  54  and the incision so that slippage of tissue in contact with the rear surface  60  of each of blades  52 ,  54  is less likely to occur relative to conventional retractors. In this manner, trauma to the tissue is minimized and exposure of the surgical site is maximized. 
         [0049]    Each of the blades  52 ,  54  is removably secured to one of the opposing arms  14 ,  16  by a coupling assembly  78 . In the exemplary embodiment, the coupling assembly  78  is a ball-and-socket assembly  78  that permits various degrees of movement between each of the opposing arms  14 ,  16  and its respective blade  52 ,  54 . It is foreseen, however, that the coupling assembly  78  could be any like assembly that permits a degree of movement between each of the opposing arms  14 ,  16  and its respective blade  52 ,  54 . 
         [0050]    The ball-and-socket assembly  78  includes a circumferential ring  80 , a ball  82 , and a socket  84 . The ball  82  depends from the circumferential ring  80 , which is connected to an elbow extension portion  86  of each of the opposing arms  14 ,  16 . The ring  80  has a circumferential abutment surface  88  about a perimeter of the ring  80  between the ring  80  and the ball  82 . The ball  82  is sized and shaped to be removably received within and at least partially housed by the socket  84 . The socket  84  is secured to the top edge  66  of each of the opposing blades  52 ,  54  has a circumferential wall  90  with an abutment ridge  92  and a cavity  94  therein. The circumferential wall  90  of the socket  84  has a degree of resiliency to permit the ball  82  to snap-fit into the socket  84  and to permit the ball  82  to rotate about the socket  84  without becoming disengaged therefrom. 
         [0051]    Regarding the snap-fit of the ball  82  and the socket  84 , the surgeon may selectively engage or disengage the ball  82  from the socket  84  by applying a degree of force (e.g., by pushing the ball  82  and socket  84  toward each other so that the circumferential abutment surface  88  abuts the abutment ridge  92  at a predetermined angle that causes the ball  82  to separate from the socket  84 , or by pulling the ball  82  and socket  84  away from each other). The degree of force necessary to separate the ball  82  from the socket  84  via abutting the circumferential abutment surface  88  and the abutment ridge  92  is less than the degree of force necessary to separate the ball  82  from the socket  84  via pulling them apart. Additionally, the degree of force necessary to engage or disengage the ball  82  from the socket  84  is greater than the force exerted on the ball-and-socket assembly  78  during usage of the retractor  10 . 
         [0052]    Regarding the rotation of the ball  82  within the socket  84 , each of the opposing arms  14 ,  16  provide its respective blade  52 ,  54  with a degree of movement independent from its arm  14 ,  16  along an X axis, a Y axis, and a Z axis, which are defined by its arm  14 ,  16  via the ball  82 . As illustrated in  FIG. 4 , the X axis runs parallel to the opposing arms  14 ,  16  and elongated body  12  or horizontally (i.e., side to side), the Y axis runs vertically to the X axis (i.e., up and down), and the Z axis runs horizontally at 90 degrees to the X axis. In this manner, when one of both of the blade  52 ,  54  are secured to the opposing arms  14 ,  16 , that is, when each ball  82  is engaged to each socket  84 , each of the blades  52 ,  54  are operable to move in one or more of the X, Y, and Z axes independent from the opposing arms  14 ,  16  and each other. 
         [0053]    The range of movement between the ball  82  and the socket  84  along the X and Z axes is limited by the ring  80 . In the exemplary embodiment, the circumferential abutment surface  88  about the perimeter of the ring  80  is operable to abut the ridge  92  of the socket  84  when the ball  82  and socket  84  pivots and reaches its limit along the X and/or Z axes. In the exemplary embodiment, the degree of pivot between the ball  82  and the socket  84  along the X and Z axes is in the range of 30 to 60 degrees and preferably 45 degrees. The degree of pivot between the ball  82  and the socket  84  along the Y axis is unlimited, (i.e., the blade  52 ,  54  may continuously rotate with respect to the arm  14 ,  16 ). It is foreseen that the ring  80  may be equipped with an extension or backstop (not illustrated) that depends from the ring  80  and is operable to abut the rear surface  60  of the blade  52 ,  54  and define a degree of pivot between the ball  82  and the socket  84  along the Y axis of, for example, 270 degrees. 
         [0054]    In use, the surgeon makes a surgical incision  96  adjacent to a surgical site  98  (e.g., a broken bone). The surgeon then grips the retractor  10  so that the void  36  between the opposing extensions  28 ,  30  is maximized, which causes the void  22  between the opposing arms  14 ,  16  and the blades  52 ,  54  to be minimized (i.e., the retractor  10  is in the first or stored configuration). If the retractor  10  is not in the compressed configuration, the surgeon may alter the configuration of the retractor  10  by moving the lever  40  of the locking assembly  38  so that the point  50  disengages from the tab  42  and expanding the opposing extensions  28 ,  30  so that the opposing arms  14 ,  16  are compressed and are more easily inserted into the incision  96 . 
         [0055]    The blades  52 ,  54  are then inserted into the incision  96  so that the rear surface  60  of each of the blades  52 ,  54  abuts tissue  100  on either side of the incision  96  and the talons  72  abut an internal part  102  (e.g., portions of the bone adjacent to the broken bone) of the surgical site  98  and/or is received within the cavity of the face  56 . It is foreseen that the talons  72  may be omitted so that the bottom edge  68 , face  56 , and/or the side edges  62 ,  64  abut the internal part  102  without deviating from the scope of the present inventive concept. 
         [0056]    Once the retractor  10  has been properly positioned with the talons  72  abutting the internal part  102  or the bottom edge  68 , face  56 , and/or the side edges  62 ,  64  abutting the internal part  102 , the blades  52 ,  54  are unable to pivot along the Y axis and secure the tissue  100  away from the surgical site  98 . The curved design of the blades advantageously minimizes pressure on the tissue  100  and/or surrounding nerves, vessels, and soft tissues (not illustrated). 
         [0057]    Depending on the application, the surgeon may be required to alter the configuration of the retractor  10  during insertion of the blades  52 ,  54  and positioning of the talons  72  to permit the internal part  102  of the surgical site  98  to be accommodated in the void of the planar face  56  between the opposing arms  14 ,  16 . Additionally, the blades  52 ,  54  may be required to pivot along one or more of the X, Y, and Z axes during insertion of the blades  52 ,  54  to accommodate the size and shape of the internal part  102  so that the curved body  74  of the blades  52 ,  54  receives, abuts, and partially enwraps the internal part  102 , and the points  76  of the talons  72  extend past the internal part  102  and underneath the internal part  102 , as illustrated in  FIG. 8  so that the internal part  102  is received in or adjacent to the cavity of the face  56 . In this manner, a pivot point between the present invention and the internal part  102  is created at or adjacent to the cavity of the face  56  and the blades  52 ,  54  are slidably and pivotably secured to the surgical site  98  and particularly to the internal part  102  without piercing the internal part  102  or otherwise damaging any other area of the patient. 
         [0058]    After the talons  72  are abuttingly secured against and/or slightly beneath the internal part  102  of the surgical site  98 , the surgeon unlocks the locking assembly  38  and alters the configuration of the retractor  10  at the pivot point (point of contact between the present invention and the internal part  102 ) so that the void  36  between the opposing extensions  28 ,  30  is minimized, which causes the void  22  between the opposing arms  14 ,  16  and the blades  52 ,  54  to be maximized (i.e., the retractor  10  is moved to the second or in-use configuration), as illustrated in  FIG. 9 . At the point, the primary positioning of the retractor  10  is complete. The retractor  10  is also subject to automatic and/or selective secondary positioning as follows. 
         [0059]    As the retractor  10  is altered from the stored configuration to the in-use configuration, each of the blades  52 ,  54  pivots independently with respect to the opposing arms  14 ,  16  along the X, Y and Z axes. The blades  52 ,  54  are not anchored to the internal part  102  and are operable to automatically and slidable move relative to the internal part  102 , if necessary, to minimizes stress on the tissue  100  of the incision  96 . Additionally, as the retractor  10  moves from the stored configuration to the in-use configuration, the surgeon may selectively move the blades  52 ,  54  of the retractor  10  further underneath the internal part  102  to further secure the retractor  10  to the internal part  102  and/or obtain a better perspective of the surgical site  98 . This automatic and/or selective secondary movement of the blades  52 ,  54  advantageously provides better leverage and a wider opening than what would have been provided without the secondary positioning of the retractor. When the retractor  10  is in the in-use configuration, the contact area between the rear surface  60  and edge portions  70  of each of the blades  52 ,  54 , and the tissue  100  on either side of the incision  96  is maximized so that the likelihood of any slippage of the tissue  100  is decreased relative to conventional retractors. The retractor  10  is then locked in the in-use configuration via the locking assembly  38 . It should also be noted that the retractor  10 , enables the surgeon to make slight adjustments, as desired, during the course of a surgical procedure via the secondary movement. 
         [0060]    Accordingly, the retractor  10  is operable to open the surgical site  98  to a maximum while maximizing contact area between the tissue  100  and the blades  52 ,  54  and leveraging on the internal part  102  of the surgical site  98  so that slippage of the retained tissue  100  with respect to the blades  52 ,  54  and inadvertent movement of the retractor  10  with respect to the surgical site  98  is prevented, and repositioning of the retractor  10  is less likely to be required by the surgeon. Thus, the present inventive concept ensures that the time required to perform a surgical procedure with the retractor  10  is kept to a minimum relative to convention retractors, which causes trauma, recovery time, risk, and costs of the surgical procedure to be minimized relative to convention retractors. 
         [0061]    Having now described the features, discoveries and principles of the general inventive concept, the manner in which the general inventive concept is constructed and used, the characteristics of the construction, and advantageous, new and useful results obtained; the new and useful structures, devices, elements, arrangements, parts and combinations, are set forth in the appended claims. 
         [0062]    It is also to be understood that the following claims are intended to cover all of the generic and specific features of the general inventive concept herein described, and all statements of the scope of the general inventive concept which, as a matter of language, might be said to fall therebetween.