tissue heating, thus avoiding unintended injury. For larger surgical defects, local, uniform pressure can be applied with the locked jaws of the hemostat parallel to the wound edge while holding the instrument at its base, which is at a safe distance from the wound (Fig 2). If bleeding is likely fed from a vessel with a known path, the pressure may be directed closer towards that vessel’s origin and at an even greater distance from the wound (eg, at the eyebrow to block the supra-orbital artery). In addition to improved safety, other advantages of this technique include the fact that it is nearly universally applicable, is easy to perform for even an untrained assistant, and does not require additional instruments on the surgical tray. An important limitation exists in that deeper layers must offer some resistance to the pressure. Various articles have described similar techniques of temporary hemostasis using pressure from firm devices; however, these either used specially-made instruments or were anatomically limited in their scope of application. In summary, this technique offers a fast and convenient method for temporary hemostasis that is safely and easily performed by assistants with little experience, and therefore may be especially helpful in a training environment. REFERENCES 1. Yen A, Braverman IM. Ultrastructure of the human dermal microcirculation: the horizontal plexus of the papillary dermis. J Invest Dermatol 1976;66:131-41. 2. Grabb WC. A concentration of 1:500,000 epinephrine in a local anesthetic solution is sufficient to provide excellent hemostasis. Plast Reconstr Surg 1979;63:834. 3. Rudolph H, Gartner J, Studtmann V. Skin lesions following the use of a tourniquet. Unfallchirurgie 1990;16:244-51. 4. Sawchuk WS, Friedman KJ, Manning T, Pinnell SR. Delayed healing in full thickness wounds treated with aluminum chloride solution. A histologic study with evaporimetry correlation. J Am Acad Dermatol 1986;15:982-9. 5. Armstrong RB, Nichols J, Pachance J. Punch biopsy wounds treated with Monsel’s solution or a collagen matrix. A comparison of healing. Arch Dermatol 1986;122:546-9. 6. Boyer JD,Maino KL, Zitelli JA. Surgical pearl: hemostasis assisted with two skin hooks. J Am Acad Dermatol 2002;47:938-9. 7. Fante RG, Fante RL. Perspective: the physical basis of surgical electrodissection. Ophthal Plast Reconstr Surg 2003;19:145-8. 8. Hafner J, Hohenleutner U. Surgical pearl: A flat plastic cylinder derived from a disposable syringe effectively achieves hemostasis in carbon dioxide laser surgery. J Am Acad Dermatol 2001;45:277-8. 9. Wheeland RG, Gilmore WA, Morgan RJ. Use of a nonconductive acrylic ring for control of bleeding during minor skin surgery. J Dermatol Surg Oncol 1983;9:18-9. 10. Sharquie KE, Al-Rawi JR. Sharquie’s metal ring in skin surgery. Dermatol Surg 2000;26:163-4. 11. Harahap M. Excision of small skin lesions on the scalp. In: Robins P, editor. Surgical gems in dermatology. Vol 1. New York: Journal Publishing Group; 1988. pp. 73-4. J AM ACAD DERMATOL SEPTEMBER 2005 498 Pearls