A ratchet assembly for multi-dimensional movement and placement of a retractor blade includes a retractor blade holder, a housing member, a rotating indexer and a self-retaining locking mechanism. The retractor blade holder is shaped and dimensioned to receive a stem of a retractor blade and includes a locking mechanism that enables selective lateral adjustment of the retractor blade relative to the retractor blade holder. The retractor blade holder is mated to the housing member and is vertically pivotable with respect to the housing member to enable selective vertical pivoting adjustment of the retractor blade relative to the housing member. The rotating indexer is mated to the housing member, and the housing member is rotatable with respect to the rotating indexer so that the retractor blade holder, the housing member and the retractor blade are able to selectively rotate about the longitudinal axis of the rotating indexer. The rotating indexer is shaped and dimensioned to mount onto a rim of a surgical support. The self-retaining locking mechanism simultaneously locks or unlocks the position of the housing member relative to the rotating indexer and the position of the rotating indexer and the entire ratchet assembly onto the rim of the surgical support.
