A modification of the McKenzie silver clip.

Abstract

In 1911 Harvey Cushing 1 introduced the silver clip as a means of hemostasis in neurological surgery. The original clip was made by winding silver wire in a t ight coil around an oval or diamond-shaped rod and then cutting off the individual clips with a wire cutter. This made small U-shaped bits of wire which were then held in the jaws of an ordinary clamp for application to the blood vessels. The author has never used the original Cushing clips, but according to McKenzie ~ the sides of the clips were often uneven in length, the ends rough, and the round wire caused a tendency for the clip to turn in the holder. McKenzie in 1927 devised the instruments now in use: a punch which cuts out perfectly uniform V-shaped clips from a flat wire, and special clip holders for applying them. I t has been our experience tha t the V-shaped clips also have a tendency to wobble, and that they are easily dislodged when applying them since only the tips of the open end of the V come in contact with the grooves in the holder. Furthermore, we found tha t when applying a clip to a large blood vessel occasionally the vessel was squeezed out of the clip or only pinched by the open ends (Fig. 1, a). To overcome this we had instruments made similar to those of McKenzie, but which punched out Ushaped, flat wire clips instead of the V forms. These were placed in an apFro. 1. Drawings comparing use of (a) V-shaped, propriately U-shaped magazine. and (b) U-shaped silver clips. The clip holder is the same as McKenzie's except that it is made slightly heavier to prevent a tendency of the jaws to spring a little due to the necessity of a little more force needed in flattening out the clip. In Fig. 1, b it will be seen that the parallel sides of the U-shaped clip give a longer area of firm contact in the grooves of the holder, thus preventing any turning or