Powell's Pearls: Eponyms in Medical and Surgical History. The Smead-Jones Closure of Abdominal Wounds

Abstract

1 Professor Powell initially produced “Powell’s Pearls,” which were short history lessons about physicians who developed surgical instruments and operations, for his residents in the program at New Hanover Regional Medical Center in Wilmington, NC beginning in 1994. Since 1998, more than 100 “Pearls” have been published in Journal of Pelvic Surgery, Obtetrical and Gynecological Survey, ACOG Clinical Review, and ournal of Pelvic Medicine and Surgery. In the early days of abdominal surgery, wound dehiscence as common and associated with significant mortality. Over he years, better suture materials and wound closure techniques ave reduced this complication. William Wayne Babcock 1872–1963) was the first to publish about the use of alloy steel ire for abdominal closure. The method with the lowest risk of ound dehiscence was described in the classic article by homas E. Jones, Edward T. Newell, Jr., and Robert E. Bruaker of the Cleveland Clinic in 1941. Dr. Jones and his colleagues reported no disruptions in 116 cases of abdominoperineal resections with steel wire closures compared with 3.9% disruption rate in 76 cases using catgut in layers with stay sutures. In a footnote, they attributed the stitch technique to Dr. Louis Smead of Toledo, Ohio. They spelled Dr. Smead’s first name incorrectly. His name is actually Lewis Frederic Smead. This suture technique was devised by Dr. Smead during his surgical internship and residency under John Miller Turpin Finney, Sr., at Union Protestant Infirmary in Baltimore, Maryland (1905–1908). The name of Union Protestant Infirmary was changed to Union Memorial Hospital in 1920. The technique involves a figure-of-eight suture passing through anterior rectus fascia, rectus muscle, posterior fascia, and peritoneum on both sides. One end is then passed through the anterior fascia on both sides again. The wire ends were cut flush with the jaws of a hemostat, which was clamped snugly against the knot. The hemostat was then rotated 180 degrees, turning the ends downward. A smooth knot was thus presented to the subcutaneous