Tissue Forceps Compared: Adson, DeBakey, Toothed vs Smooth

Tissue forceps are among the most used instruments in any operating room, treatment room or suture kit. Most look the same at first sight: two spring-steel arms joined at one end. The difference lies at the tips, and that is where the names Adson, DeBakey, “toothed” and “non-toothed” come in. This guide explains how thumb forceps work, what the common tip patterns are for, and how the Adson and DeBakey patterns compare.

How thumb forceps work

Thumb forceps (also called tissue forceps, dressing forceps or “pick-ups”) are non-locking forceps. They are held like a pen between the thumb and index finger, with the top end resting in the web of the thumb. Spring tension keeps the tips apart until the user squeezes them, so the grip can be varied finely and released at once.

Wikipedia’s forceps article lists their main uses: holding tissue still while sutures are placed, moving tissue gently aside during exploration, and reaching into confined spaces that fingers cannot. Unlike hemostats, they have no ratchet, so they hold only as long as the user keeps squeezing.

Toothed vs non-toothed forceps

The tip pattern defines the instrument. There are two broad groups.

Non-toothed forceps

Non-toothed tips may be smooth, cross-hatched or finely serrated. Wikipedia notes that smooth or cross-hatched tips are used for moving dressings and removing sutures. Finely serrated, non-toothed forceps are used on tissue that must not be pierced, such as blood vessels and bowel. The American College of Surgeons’ student guide describes plain tissue forceps as non-toothed forceps for fine handling of tissue and traction during dissection.

Toothed forceps

Toothed forceps have small interlocking teeth, sometimes called “mouse’s teeth” or “rat-tooth”, at the tips. The common arrangement is 1×2: a single tooth on one tip meshes between two teeth on the other. Other patterns include 7×7 and 9×9 rows.

It might seem that teeth would always damage tissue more than a smooth tip. Wikipedia points out the opposite can be true: because teeth hold tissue securely, less overall pressure is needed, so toothed forceps can cause less damage than smooth ones on tough tissue such as skin and fascia. For vessels and other delicate tissue, non-toothed atraumatic patterns such as the DeBakey are used instead, so the tissue is not pierced.

	Toothed	Non-toothed (smooth, cross-hatched or serrated)
Tip	Interlocking teeth, commonly 1×2	Flat grip surface with grooves or none
Grip	Secure on tough tissue with light pressure	Spreads pressure over a wider area
Typical use	Skin, fascia, dense tissue	Vessels, bowel, delicate tissue; dressings and suture removal (smooth tips)
Examples	Adson 1×2, Adson-Brown, rat-tooth forceps	DeBakey, smooth dressing forceps, Adson non-toothed

Adson forceps

Adson forceps are short, fine-tipped thumb forceps. They are named after Alfred Washington Adson, the Mayo Clinic neurosurgeon whose name is on several other instruments.

The ACS guide describes Adson forceps as toothed at the tip and used for handling dense tissue, such as in skin closures. The most common pattern is 1×2 teeth. However, the Adson name is also used for non-toothed versions with serrated or smooth tips, so the name alone does not tell you the tip. Catalogues also offer micro tips, tungsten carbide tips, and stainless steel or titanium bodies. Common catalogue lengths are around 12 cm.

Adson-Brown forceps

The Adson-Brown (or Brown-Adson) is a variant with rows of many small teeth along each tip instead of a single 1×2 set. Like the standard Adson, it is used to hold tissue during skin closure and in small wounds.

DeBakey forceps

DeBakey forceps are atraumatic tissue forceps developed by Michael DeBakey at Baylor College of Medicine. They were designed for vascular procedures, where vessels must be handled without injury. Wikipedia notes that they are among the most widely used forceps in cardiothoracic, vascular, and head and neck surgery. The ACS guide lists them for atraumatic tissue grasping during dissection.

The tips are non-toothed, so they hold vessels and delicate tissue without piercing them. A visible feature is the grip panel, which Wikipedia describes as distinctly coarsely ribbed, unlike the finer ribbing on most other tissue forceps. They are made in a wide range of lengths. Wikipedia notes some examples are over 12 inches long, for deep fields. Tip widths vary between models, and insulated versions with exposed tips are made for use with monopolar electrosurgery.

Adson vs DeBakey at a glance

Feature	Adson	DeBakey
Typical tip	1×2 teeth (non-toothed versions exist)	Atraumatic, non-toothed
Typical length	Short (catalogue lengths around 11 to 15 cm)	Wide range, including long versions
Grip panel	Standard ribbing	Distinctly coarse ribbing
Typical tissue	Skin and dense tissue, small wounds	Blood vessels and delicate tissue
Typical setting	Skin closure and small wounds	Vascular, cardiothoracic, head and neck surgery

Other common tissue forceps

• Bonney forceps: heavy toothed forceps for thick tissue, such as fascial closure, according to the ACS guide.
• Russian forceps: listed by the ACS guide, like the DeBakey, for atraumatic tissue grasping during dissection.
• Potts-Smith tissue forceps: long thumb forceps with 1×2 teeth.
• Fine ophthalmic forceps, such as Castroviejo suturing forceps, for microsurgery.

What to check when ordering

• Tip pattern: 1×2 teeth, multiple teeth, serrated, cross-hatched or smooth. Do not rely on the pattern name alone.
• Tip width: standard, delicate or micro. DeBakey forceps in particular are listed by tip width.
• Length in cm or inches.
• Shape: straight, angled or bayonet.
• Material: stainless steel, titanium, or tungsten carbide tips.
• Reusable or single-use: simple thumb forceps are widely sold in both forms.

Our guide to reading a surgical instrument catalogue explains how these options are usually coded.

Browse the patterns

You can compare catalogue lengths and companies on our pages for Adson tissue forceps, DeBakey forceps and thumb forceps, or see all forceps in the database. For locking forceps used to control bleeding, see our comparison of hemostats.

This article is general reference information about instrument design, not clinical guidance.

Sources

• American College of Surgeons, Division of Education: Common Surgical Instruments (student module)
• Wikipedia: Forceps
• Wikipedia: DeBakey forceps
• Wikipedia: Alfred Washington Adson
• Wikipedia: Kelly forceps (section on thumb forceps tip patterns)