Backhaus Towel Clip
Penetrating, sharp-pointed ring-handled clamp used to secure sterile drapes to the patient's skin and to each other during surgical draping — the workhorse instrument for establishing and maintaining the sterile field. Named for Backhaus, a German surgeon of the late 19th / early 20th century. Ubiquitous on every reconstructive-urology and urogyn tray for the framing of the operative field at perineal, scrotal, vaginal, abdominal, and combined-position cases.
Design
- Two curved, sharp-pointed jaws that cross and ball-and-socket interlock when closed, gripping drape material between the points.
- Box-lock ratchet holds the clamp closed during the case; ring handles for single-handed operation.
- Stainless steel, reusable, autoclavable.
- Sizes ~ 8–13 cm overall length (smaller "baby" versions for pediatric and delicate cases).
Reconstructive-Urology and Urogyn Uses
Primary — sterile-field securement
- Anchoring sterile drapes to skin at the margins of the operative field; 4–6 clips typically define the field for perineal, abdominal, or combined approaches.
- Drape-to-drape fixation at overlaps to eliminate gaps — particularly important in combined-position urogyn cases (eg, abdominal + perineal for transperineal rectourethral / rectovaginal fistula repair, or lithotomy-to-supine conversion).
Secondary uses
- Securing tubing and cables to drapes — suction, cautery, light cords, irrigation lines — keeping them out of the surgeon's field and off the floor.
- Temporary tissue grasp — occasional use as a heavy-skin-edge or eschar grasp (Tadiparthi 2007 describes paired towel clips creating a "tenting effect" for linear burn debridement on the trunk).[1]
- Reduction of skin / fascial gaps in dirty trauma or emergent damage-control wound management.
Penetrating vs Non-Penetrating Towel Clamps
| Feature | Backhaus (penetrating) | Non-penetrating (Edna / Lorna / Jones) |
|---|---|---|
| Tip | Sharp, points through drape and into superficial dermis | Broad / flat / ball — compression-grip only |
| Grip strength | Strong — mechanical interlock | Weaker — friction / compression |
| Skin puncture | Yes — paired puncture marks | None |
| Field integrity for airtight / barrier drapes | Breaches drape and skin | Maintains seal |
| Common use | Standard OR draping | Cosmetic-sensitive sites; airtight barrier drapes (eg, David 2020 negative-pressure COVID skull-base drape)[2] |
Technique
- Position the sterile drape at the field margin.
- Open the clamp; place one jaw beneath the drape (against skin), the other jaw on top.
- Close so the points pass through drape and into superficial dermis; engage the ratchet.
- Typically 4–6 clips define the four corners / margins of the operative field.
- Remove before drape take-down at case end; the punctures heal without intervention.
Safety and Care Considerations
- Sharps injury — the points are a needlestick-level hazard on application, removal, and during pass-off; handle as a sharp.
- Drape dislodgement — under traction the clip can pull free; reapply rather than retorque against the field.
- Surgical count — small, peripheral, easily overlooked; include in the count.
- Cosmetic-sensitive sites — paired puncture marks may be visible on the face, neck, or anterior chest; consider non-penetrating clamps or alternate fixation in cosmetic-genital and gender-affirming surgery near visible skin.
- Nickel-chromium contact allergy — Lhotka 1998 found nickel sensitivity in 18% of men and 23% of women, with positive correlation between nickel-allergy grade and skin-clip reactions.[3]
- Maintenance — inspect tip alignment (misaligned points fail to interlock); verify the ratchet engages crisply; replace dull tips that tear drape rather than penetrating cleanly.
- SSI prevention — WHO 2016 recommendations frame sterile-field integrity (which the towel clip helps maintain) as one element of multimodal SSI prevention.[4]
Variations
- Standard Backhaus — the routine version.
- Baby Backhaus — smaller, for pediatric and delicate cases.
- Roeder — similar penetrating geometry with slightly different jaw profile.
- Lorna / Edna — the standard non-penetrating alternative.
See also: Allis Clamp, Kocher Clamp.
References
1. Tadiparthi S, Azad S, James MI. "A simple method for linear burn debridement." Burns. 2007;33(1):98–9. doi:10.1016/j.burns.2006.04.012
2. David AP, Jiam NT, Reither JM, et al. "Endoscopic skull base and transoral surgery during COVID-19 pandemic: minimizing droplet spread with negative-pressure otolaryngology viral isolation drape." Head Neck. 2020;42(7):1577–82. doi:10.1002/hed.26239
3. Lhotka CG, Szekeres T, Fritzer-Szekeres M, et al. "Are allergic reactions to skin clips associated with delayed wound healing?" Am J Surg. 1998;176(4):320–3. doi:10.1016/s0002-9610(98)00197-4
4. Allegranzi B, Zayed B, Bischoff P, et al. "New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective." Lancet Infect Dis. 2016;16(12):e288–303. doi:10.1016/S1473-3099(16)30402-9