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Hemostatic clamp for skin
NEW
INSTRUMENT
Hemostatic
Clamp
for Skin
CARLOSALBARRANT.. M.D., Mexico City, Mexico
From the Department of Surgery, Hospital 20 de NoGembre, I.S.S.S.T.E., Hospital Central M&tar and Escuela Medico Militar, Mexico City, Mexico.
every surgical incision, the plane that I Nbleeds most frequently and abundantly is the dermis because of its rich capillary network. The cellular tissue, aponeurotic layer, and muscles possess larger blood vessels which are less numerous and more easily clamped and tied. The prophylactic use of various products which act as capillary hemostatics has not given satisfactory results and does not prevent hemostasis of the dermis. The hemostatic ligatures in this plane are frequently multiple, difficult to perform, timeconsuming, poorly tolerated by the patient, interfere with healing of the edges of the skin, and produce defective and unesthetic scars. Placing compresses on the wound edges, whether or not plastic is to be applied, gives additional security against infection, contamination, or external irritation and is therefore always recommended. These compresses are usually placed on the edges of the skin except during operation for internal septic processes when contamination of the cellular tissue is to be avoided. In this case the compresses should be placed on the anterior aponeurotic layer. To avoid superficial hemostatic ties in the dermis and at the same time allow the placement of field compresses, a stainless steel hemostatic clamp (patent pending) has been devised which is herein described. DESCRIPTION
OF THE
INSTRUMENT
The instrument consists of a solid angled stem (Fig. IA) which at one end has a small perpendicular metal plate with small teeth in its
lower edge and at the other end has a spiral thread for a circular screw. The stem slides on a hollow metallic tube (Fig. IB), one of whose ends is a perpendicular toothed plate that corresponds to the plate previously described and at the other end is a T-shaped plate for the placing of fingers and exerting pressure to open the mouth of the clamp. In the upper section of the clamp is a spring (Fig. 1C) whose tone can be regulated by the circular screw and which firmly holds together the two toothed-plates. A guide prevents the two plates from rotating. The area of hemostatic pressure of each clamp is 3 cm2. The full length of the instrument is 9 cm. TECHNIC
The skin incision is made 2 to 3 cm. deep in the cellular tissue without clamping the bleeding capillary vessels in the dermis; the borders of the compresses are joined to the edges of the wound, holding both with the clamps. (Fig. 2.) As many clamps as necessary are used to control the hemorrhage. The same maneuver is carried out on the opposite edge of the wound. Backhaus clamps are placed at the ends of the incision to join the compresses and the few blood vessels found in the deeper planes are clamped and tied. In a 20 cm. incision eight to ten clamps are used depending on the amount of capillary bleeding. These clamps keep the surgical field dry; moreover, superficial hemostasis is speeded by the avoidance of sutures that provoke reactions and intolerance to the material used. (Fig. 3.) On removing the clamps and field compresses, occasionally some small vessels bleed. 144
The Am&can
Journal
of Surgery
Hemostatic t------
11.5
I r
8.9
FIG. 1. A, B, and C, the different ments given are in centimeters.
Clamp for Skin
parts of the hemostatic
clamp for the skin are shown. Measure-
\
FIG. 2. Schematic
drawing of tl-le clamp grasping
FIG. 3. A series of clamps in position cover the clamps.
before the compress
These are not clamped but are included in the suture of the skin, thus stopping the hemorrhage. We have used this procedure for eight years in multiple operations. No zones of necrosis or delays in the formation of scar tissue have been observed. The only objection to the use of these metallic clamps is in operations that require x-ray therapy during the operation as the clamps interfere with the x-ray plates. This could be
VOL. I16,
July 1968
the skin and the compresses. on one side is turned over to
avoided by producing paque plastic material.
a clamp
of nonradio-
CONCLUSIONS
A new type of hemostatic clamp for the skin that simultaneously holds the compresses in the surgical field is described. The use of this clamp reduces operating time, eliminates superficially placed suture material, and avoids the corresponding inconveniences. We have not observed delays in healing, necrosis, or esthetic defects.
INSTRUMENT
Hemostatic
Clamp
for Skin
CARLOSALBARRANT.. M.D., Mexico City, Mexico
From the Department of Surgery, Hospital 20 de NoGembre, I.S.S.S.T.E., Hospital Central M&tar and Escuela Medico Militar, Mexico City, Mexico.
every surgical incision, the plane that I Nbleeds most frequently and abundantly is the dermis because of its rich capillary network. The cellular tissue, aponeurotic layer, and muscles possess larger blood vessels which are less numerous and more easily clamped and tied. The prophylactic use of various products which act as capillary hemostatics has not given satisfactory results and does not prevent hemostasis of the dermis. The hemostatic ligatures in this plane are frequently multiple, difficult to perform, timeconsuming, poorly tolerated by the patient, interfere with healing of the edges of the skin, and produce defective and unesthetic scars. Placing compresses on the wound edges, whether or not plastic is to be applied, gives additional security against infection, contamination, or external irritation and is therefore always recommended. These compresses are usually placed on the edges of the skin except during operation for internal septic processes when contamination of the cellular tissue is to be avoided. In this case the compresses should be placed on the anterior aponeurotic layer. To avoid superficial hemostatic ties in the dermis and at the same time allow the placement of field compresses, a stainless steel hemostatic clamp (patent pending) has been devised which is herein described. DESCRIPTION
OF THE
INSTRUMENT
The instrument consists of a solid angled stem (Fig. IA) which at one end has a small perpendicular metal plate with small teeth in its
lower edge and at the other end has a spiral thread for a circular screw. The stem slides on a hollow metallic tube (Fig. IB), one of whose ends is a perpendicular toothed plate that corresponds to the plate previously described and at the other end is a T-shaped plate for the placing of fingers and exerting pressure to open the mouth of the clamp. In the upper section of the clamp is a spring (Fig. 1C) whose tone can be regulated by the circular screw and which firmly holds together the two toothed-plates. A guide prevents the two plates from rotating. The area of hemostatic pressure of each clamp is 3 cm2. The full length of the instrument is 9 cm. TECHNIC
The skin incision is made 2 to 3 cm. deep in the cellular tissue without clamping the bleeding capillary vessels in the dermis; the borders of the compresses are joined to the edges of the wound, holding both with the clamps. (Fig. 2.) As many clamps as necessary are used to control the hemorrhage. The same maneuver is carried out on the opposite edge of the wound. Backhaus clamps are placed at the ends of the incision to join the compresses and the few blood vessels found in the deeper planes are clamped and tied. In a 20 cm. incision eight to ten clamps are used depending on the amount of capillary bleeding. These clamps keep the surgical field dry; moreover, superficial hemostasis is speeded by the avoidance of sutures that provoke reactions and intolerance to the material used. (Fig. 3.) On removing the clamps and field compresses, occasionally some small vessels bleed. 144
The Am&can
Journal
of Surgery
Hemostatic t------
11.5
I r
8.9
FIG. 1. A, B, and C, the different ments given are in centimeters.
Clamp for Skin
parts of the hemostatic
clamp for the skin are shown. Measure-
\
FIG. 2. Schematic
drawing of tl-le clamp grasping
FIG. 3. A series of clamps in position cover the clamps.
before the compress
These are not clamped but are included in the suture of the skin, thus stopping the hemorrhage. We have used this procedure for eight years in multiple operations. No zones of necrosis or delays in the formation of scar tissue have been observed. The only objection to the use of these metallic clamps is in operations that require x-ray therapy during the operation as the clamps interfere with the x-ray plates. This could be
VOL. I16,
July 1968
the skin and the compresses. on one side is turned over to
avoided by producing paque plastic material.
a clamp
of nonradio-
CONCLUSIONS
A new type of hemostatic clamp for the skin that simultaneously holds the compresses in the surgical field is described. The use of this clamp reduces operating time, eliminates superficially placed suture material, and avoids the corresponding inconveniences. We have not observed delays in healing, necrosis, or esthetic defects.