Surgical Pearl: Hemostasis assisted with two skin hooks

Abstract

H emostasis is an essential but sometimes tedious and time-consuming aspect of cutaneous surgery. The importance of achieving hemostasis is stressed in numerous textbooks on cutaneous surgery, but details on efficient attainment of that goal are not.1-5 We describe an efficient technique that requires minimal investment in instrumentation and provides a clear division of labor between surgeon and assistant. The surgical assistant uses 2 skin hooks in unison to provide broad visualization of the wound bed and undermined skin flap, which is reflected for complete exposure (Fig 1). Intraoperative bleeding is focally controlled with tension tamponade achieved by the assistant exerting tension (stretch) on the skin flap (Fig 1) and digital pressure to bleeding vessels observed in the immediate wound vicinity (Fig 2). Once the skin hooks are engaged into the skin edge, they may be rotated 90° to 180° toward the wound and away from the assistant’s digit for added safety. With excellent exposure, the surgeon is free to efficiently visualize and target vessels with direct pressure using a sterile cotton-tipped applicator and to pinpoint electrodesiccation while the assistant provides tension and pressure control of hemorrhage. Because the surgeon individually targets, blots, and electrodesiccates the chosen vessel, the often awkward coordination and mistiming that may occur when these tasks are shared with the assistant are eliminated.