Part, twist and clip

Sir,

We have all battled with incisions within or adjacent to hair bearing areas, most often on the scalp: examples include sebaceous cysts as basic surgical trainees, neoplastic lesions as higher surgical trainees, and face or brow lifting procedures as consultants. We hesitate to disrupt the preferred preoperative coiffure, and rarely shave or cut the hair short. We accept intermittent sub optimal visibility and inconvenience, and we routinely face the inevitable tangled mess at the end of the procedure; hair matted with blood clot and pieces of flesh. Can I suggest the use of artery clips to help restore calm? After determining and marking the site of the incision(s), part small clumps of hair to reveal the ink markings, twist the hair of each clump en masse along its length in the most favourable direction, and gently clip the braid, catching the ends of the hair together with the drape if desired. The weight of the clip and gravity maintain hair displacement and good visibility (Fig. 1, Fig. 2) . The hair can be wrapped in part of a swab, or the drape prior to clipping if there is a risk of damaging the hair. This technique is simple and quick, even if using multiple clips. It can be used on different hair lengths, and avoids any need for trimming or shaving. The hair remains controllable, and it can be washed and cleaned easily at the end of the procedure. Obviously, hair to be excised as part of the operation can be identified and clipped separately if required. This technique is most effective when the hair is a little damp with preparation fluid or normal saline, and it avoids the need for the application of soap or grease pre-procedure.