NEW METHOD OF CLOSURE OF THE SCALP

C. HUNTER SIIELDEN, M.D.,* AND ROBERT H. PUDENZ, M.D.*

PasadeJta, California

(Received for publication Deceml)er 24, 1958)

A n y m e t h o d of closure of the scalp has two essent ia l f a c t o r s - - a p p r o x i m a t i o n of the marg ins of the wound and a d e q u a t e hemostas is .

The two- l aye r m e t h o d e m p l o y i n g silk su tures was the accep ted s t a n d a r d for m a n y years . In 1943, while in the N a v y , we began to use an inve r t ed m a t t r e s s su ture of t a n t a l u m wire for closure of the scalp. Th is m e t h o d was more rap id , al- lowed b e t t e r hemostas i s , and , when removed , lef t no foreign m a t e r i a l in the wound. Stainless steel wire has since rep laced t a n t a l u m b u t the m e t h o d of use and a d v a n - tages are s imilar .

PIG. 1. Photograp]l of scalp clips (see text).

Recen t ly , we have ( tcveloped a clip t h a t should fu r the r s impl i fy closure of the scalp, e i ther for l acera t ion or c r an io tomy .

The clipt (Fig. 1) is made of nylon, with stainless steel wire teeth so arranged that they simulate the action of the inverted mattress wire sutures. The two parts are identical, thus making it unnecessary to have matched pairs. Closure, using the inverted mattress stitch (Fig. ~2), shows the mechanical action of the wire suture. The function of the teeth on the scalp clip corresponds to that of the wire suture in one-half a stitch. The similarity of action of the wire teeth on tile clips is apparent (Fig. ~).

A group of 3 or 4 clips (enough to clo~e a 6-8 inch laceration of the scalp) can be placed in a light metal holder, sterilizer, sealed in a sterile glass tube, and made available for immediate use in an Emergency Room, or carried as emergency equipment on ambulances or in a physi- cian's bag.

* 744 Fairmount Avenue, Pasadena, California. ~( Scalp clips are available through Sierra Engineering Company, 123 East Montecito, Sierra Madre,

California.

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55~ C. H U N T E R S H E L D E N A N D R O B E R T H. P U D E N Z

FIG. ~. Diagram showing similarity in action of teeth of scalp clip and wire mattress suture.

FIG. 3. Temporal scalp incision with scalp clip in place (A and B). Wound healing after removal of clip and sutures (C).

FIG. 4~. Vascular scalp closed with scalp clips and inverted mattress wire sutures. (A) Wound on 6th postoperative day. (B) Wound after removal of clip, same day.