- Email: [email protected]
Skin closure using a new skin clip
NEW INSTRUMENT
Skin Closure Using a New Skin Clip Peter 6. Samuels, MD, Encino, California James C. &ill, MD, Encino, California
Of all the methods of closing skin wounds, the use of clips is the most rapid. A new skin clip that provides rapid skin closure with minimal trauma to the skin has been devised. The clip consists of two fine-toothed blades that are held parallel by a V-shaped bridge. It is stamped out of stainless steel. The fenestrated blades spread the pressure over a maximal area of skin. The fine teeth on the inner side of the bottom rim of the blade serve to anchor the clip at the selected depth of closure. (Figures 1 and 2.) These clips may be used anywhere on the skin surface with the exception of areas such as the
F&ore 1. Sktn cl@ showk~@ parat&/ dtsposttkm of the bk#des of the C&J and pfacement of the sheared teeth at the base of the blades where they ftx the clip In place when tt ts closed.
From the Department of Surgery, U.C.L.A.. Los Angeles, and the Surgical Service, Sepuhwda Veterans Adminlstratii Hospital, San Fernando, Californta. Reprint requests should be addressed to Peter B. Samuels, MD, 5363 Balboa Boulevard, Encino. California 91316.
Vohnm 129, March 1975
scalp, palm, and soles, where skin eversion is precluded. In other areas where the skin is scarred or the subcutaneous fat is especially firm, such as the upper part of the abdomen, it may not be possible to apply the clip because of the difficulty in everting the skin. The clip is applied with a bayonet curved applier under direct vision. (Figures 2 and 3.) Prior to application of the clip the skin edge is everted either by the surgeon or by an assistant. The clip is then allowed to seat over the opposed edges and closed. Clips are generally applied one clip length apart. (Figures 2,3, and 4.)
Figure 2. (Left upper drawtng): Detatt of cttp constructkm Is represented. (Leff center): Prectse approxhatfon of an everskm of sktn e&es wiih thumb forceps Is -wed by app&atkm of a W ct& u&r fM v&&n. Depth of pfacement ts co&o&d by the V-shaped b&&e. (R&M center): The forcq flxes the ct& on the sktn edges and stead/es the skh p&r to the next af@katkm of thumb forceps. (Bottom rlgM): Ftxatton and ever&n of the skln skk~. The wlnby the c@ car&s over to the ne@bo&g dow In the Made of the clip atk%vs for sktn swetttng.
345
Samuels and Brill
Figure 3. Photograph of the everted skin edge secured by W clip. Figure 4. Close-up of the accurate/y apposed skin edge. Clips are pl8Ced one cilp length apart, aliowing free circulation of blood to the skin edge.
In general, early removal at forty-eight to seventy-two hours will prevent any scarring of the skin. In areas under tension or subjected to stress by movement, a few supplementary sutures between the clips may be placed to ensure wound security when the clips are to be removed early. A high degree of accuracy in the placement of the clips is made possible by direct visualization of the skin edge through the clip as it is applied. The clips are removed by placing the blades of a straight or curved hemostat in the ridges at the base of the clip and opening the hemostat to separate the blades of the clip and release the underlying skin. Surgeons who regularly use clips adopted this new model at once. Others use them in place of customary clips in thyroid and sympathectomy closures. To evaluate these clips we used them in all types of closure (transverse, oblique, and vertical) involving the neck, limbs, chest, and abdomen. They are usually removed from neck wounds in three or four days, from extremities in four or five days, from transverse abdominal incisions in four days, and from vertical abdominal incisions in five to seven days. Immediately after removal the imprint of the clip and slight eversion of the skin edge are perceptible. Within twenty-four hours a vague outline re-
346
mains, and in one to two weeks a hairline scar is the sole vestige of the closure. A recent study [I] of skin clips paralleled our experience almost exactly. These clips have been used in 440 patients on the services of the Sepulveda Veterans Administration Hospital and in the private practice of one of us. This study was carried out over a four year period. At the beginning of this study, only sufficient prototypes were available for our use. Since that time, these clips have become commercially available (Edward Week) and are now used with satisfaction by other members of the service. Summary
A new skin clip that allows rapid skin closure with minimal trauma to the skin has been devised. The clip can be used in most conventional incisions on the neck, extremities, thorax, and abdomen. It cannot be used where skin is tightly adherent, as in the scalp, palm, and soles of the feet. Closure with this skin clip has proved to be dependable and to provide an aesthetic hairline scar. Reference 1. Annis D: A sterile “use-once” clip applicator for skin closure. Br J Surg 60: 686, 1973.
The Amertcan Journal of Surgery
Skin Closure Using a New Skin Clip Peter 6. Samuels, MD, Encino, California James C. &ill, MD, Encino, California
Of all the methods of closing skin wounds, the use of clips is the most rapid. A new skin clip that provides rapid skin closure with minimal trauma to the skin has been devised. The clip consists of two fine-toothed blades that are held parallel by a V-shaped bridge. It is stamped out of stainless steel. The fenestrated blades spread the pressure over a maximal area of skin. The fine teeth on the inner side of the bottom rim of the blade serve to anchor the clip at the selected depth of closure. (Figures 1 and 2.) These clips may be used anywhere on the skin surface with the exception of areas such as the
F&ore 1. Sktn cl@ showk~@ parat&/ dtsposttkm of the bk#des of the C&J and pfacement of the sheared teeth at the base of the blades where they ftx the clip In place when tt ts closed.
From the Department of Surgery, U.C.L.A.. Los Angeles, and the Surgical Service, Sepuhwda Veterans Adminlstratii Hospital, San Fernando, Californta. Reprint requests should be addressed to Peter B. Samuels, MD, 5363 Balboa Boulevard, Encino. California 91316.
Vohnm 129, March 1975
scalp, palm, and soles, where skin eversion is precluded. In other areas where the skin is scarred or the subcutaneous fat is especially firm, such as the upper part of the abdomen, it may not be possible to apply the clip because of the difficulty in everting the skin. The clip is applied with a bayonet curved applier under direct vision. (Figures 2 and 3.) Prior to application of the clip the skin edge is everted either by the surgeon or by an assistant. The clip is then allowed to seat over the opposed edges and closed. Clips are generally applied one clip length apart. (Figures 2,3, and 4.)
Figure 2. (Left upper drawtng): Detatt of cttp constructkm Is represented. (Leff center): Prectse approxhatfon of an everskm of sktn e&es wiih thumb forceps Is -wed by app&atkm of a W ct& u&r fM v&&n. Depth of pfacement ts co&o&d by the V-shaped b&&e. (R&M center): The forcq flxes the ct& on the sktn edges and stead/es the skh p&r to the next af@katkm of thumb forceps. (Bottom rlgM): Ftxatton and ever&n of the skln skk~. The wlnby the c@ car&s over to the ne@bo&g dow In the Made of the clip atk%vs for sktn swetttng.
345
Samuels and Brill
Figure 3. Photograph of the everted skin edge secured by W clip. Figure 4. Close-up of the accurate/y apposed skin edge. Clips are pl8Ced one cilp length apart, aliowing free circulation of blood to the skin edge.
In general, early removal at forty-eight to seventy-two hours will prevent any scarring of the skin. In areas under tension or subjected to stress by movement, a few supplementary sutures between the clips may be placed to ensure wound security when the clips are to be removed early. A high degree of accuracy in the placement of the clips is made possible by direct visualization of the skin edge through the clip as it is applied. The clips are removed by placing the blades of a straight or curved hemostat in the ridges at the base of the clip and opening the hemostat to separate the blades of the clip and release the underlying skin. Surgeons who regularly use clips adopted this new model at once. Others use them in place of customary clips in thyroid and sympathectomy closures. To evaluate these clips we used them in all types of closure (transverse, oblique, and vertical) involving the neck, limbs, chest, and abdomen. They are usually removed from neck wounds in three or four days, from extremities in four or five days, from transverse abdominal incisions in four days, and from vertical abdominal incisions in five to seven days. Immediately after removal the imprint of the clip and slight eversion of the skin edge are perceptible. Within twenty-four hours a vague outline re-
346
mains, and in one to two weeks a hairline scar is the sole vestige of the closure. A recent study [I] of skin clips paralleled our experience almost exactly. These clips have been used in 440 patients on the services of the Sepulveda Veterans Administration Hospital and in the private practice of one of us. This study was carried out over a four year period. At the beginning of this study, only sufficient prototypes were available for our use. Since that time, these clips have become commercially available (Edward Week) and are now used with satisfaction by other members of the service. Summary
A new skin clip that allows rapid skin closure with minimal trauma to the skin has been devised. The clip can be used in most conventional incisions on the neck, extremities, thorax, and abdomen. It cannot be used where skin is tightly adherent, as in the scalp, palm, and soles of the feet. Closure with this skin clip has proved to be dependable and to provide an aesthetic hairline scar. Reference 1. Annis D: A sterile “use-once” clip applicator for skin closure. Br J Surg 60: 686, 1973.
The Amertcan Journal of Surgery