Michel Skin Clips: Application and Removal Forceps Guide

A scalp laceration arrives at 11pm. The disposable stapler in the trolley has three staples left in a cartridge rated for thirty-five, and the store room is locked until morning. In a lot of hospitals across South Asia, Africa and Eastern Europe, what comes out next is a small stainless jar of metal bands and a single double-ended forceps that has probably been in that department longer than the doctor holding it.

That is the working reality of michel skin clips. They are not a museum piece. They are a reusable, low-cost skin closure system that still earns its place in dressing trolleys, minor ops rooms and field kits, and the instrument that drives them does two opposite jobs with the same pair of jaws.

What the clip itself is

A Michel clip is a flat band of stainless steel, roughly 7.5 mm long and 1.75 mm wide, with a sharp point turned inward at each end. Squeeze it across a wound and those two points drive through the dermis on either side of the incision line and the band arches over the top, holding the edges in apposition. There is no cartridge, no plastic body, no firing mechanism. The clip is the entire device.

Most clips are drawn from austenitic stainless — AISI 304 or 316L — because the material has to hold a formed shape after cold working and sit in tissue for seven to ten days without pitting. Martensitic grades like 420 would be wrong here; they harden well but are far less forgiving in a chloride-rich wound environment. Clips are typically supplied loose in packs of 1,000, which is why the per-closure cost lands so far below a disposable stapler.

They come in more than one size. Longer bands suit thicker scalp and trunk skin; shorter bands are used where the dermis is thin and a deep bite risks necrosing the skin bridge.

One forceps, two ends, two opposite actions

The instrument catalogues call it a “Michel clip applying and removing forceps”, and the name is literal. Look at the working end and you will find the jaws are not symmetrical.

The applying end

One side carries a shallow transverse groove that cradles the clip’s arch. The clip sits in that groove points-down, held by friction alone. Closing the handles compresses the band inward, driving both points into the skin simultaneously and bending the band into its final arch.

The removing end

The opposite end is a narrow bevelled tip designed to slide under the arch of a clip already in the skin. Closing the handles here does the reverse — it flattens the band, straightening the arch so the two points lift cleanly out of the dermis along the same track they entered.

Standard overall lengths are 12.0 cm and 12.5 cm (4¾ and 5 inches). The forceps are made from martensitic stainless, usually AISI 420, hardened to hold a crisp edge on the removal bevel. That combination matters: a soft removal tip rolls over after a few hundred cycles and starts tearing the skin bridge instead of releasing the clip.

Applying clips without leaving railway tracks

The failure mode people associate with metal skin closure — cross-hatched scarring — is almost always a technique problem, not a device problem.

Approximate before you clip

The clip holds edges that are already meeting. It does not pull them together. Have an assistant appose the edges with fine non-toothed forceps, or use skin hooks, and evert slightly so the dermal surfaces meet rather than the epidermal edges rolling inward.

Set the spacing

Roughly 8–10 mm between clips on scalp and trunk. Closer spacing does not improve the closure; it strangles the intervening skin. On a wound under tension, add deep dermal absorbable sutures first and let the clips handle apposition only.

Seat perpendicular

The band must cross the incision at 90°. An oblique clip loads one edge more than the other and produces the asymmetric puckering that gets blamed on the clip design.

Do not over-squeeze

Compression stops when the arch forms. Continuing to squeeze buries the arch into the epidermis, which is what leaves a permanent dot on either side of the scar line. You are aiming for a band that you can just slip a probe under.

Removal on day seven

Removal is where the double-ended design pays for itself, because the same instrument in the same hand does the job.

Slide the bevelled tip under the arch from the side, not from the end. Squeeze gently and continuously — the band flattens and the points withdraw. If a clip resists, it is almost always because the arch has been buried; free the overlying epidermis with the tip before applying force. Never lever the clip upward, which drags the points sideways through the dermis and is the main cause of the small punctate scars patients notice months later.

Timing follows the same logic as sutures: face 4–5 days, scalp and trunk 7–10 days, limbs and over joints 10–14 days.

Specifications at a glance

Where they still make sense

Nobody is arguing that these clips should replace a modern subcuticular closure on a paediatric facial laceration. But there are three settings where they hold ground.

Cost-sensitive high-volume closure. A thousand clips and one forceps close a very large number of wounds. Where a disposable stapler is a recurring foreign-exchange line item, that arithmetic decides procurement.

Scalp. Thick, mobile, hair-bearing, and bloody. Metal closure on scalp has always outperformed sutures for speed, and clips grip the dense scalp dermis well.

Austere and field settings. No cartridge to run out of, no expiry on the mechanism, and the whole system reprocesses in a standard autoclave. Field surgical kits still carry them for exactly this reason — the same logic that keeps other reusable patterns in portable field hospital kits.

Care, and the one thing that ruins the forceps

Clean immediately after use — dried blood in the applying groove changes the seat of the clip and causes misfires. Ultrasonic clean, rinse in demineralised water, dry fully, then lubricate the box joint with a water-soluble instrument lubricant before steam sterilisation. Never use mineral oil; it survives the autoclave cycle and shields organisms.

The single most common way these forceps are destroyed is chipping the removal bevel by using it as a general-purpose grasper. It is a thin hardened edge. Used as a hook or a wire bender, it chips, and a chipped bevel will not slide under a clip arch. Keep it in the minor ops set for its own job, the same discipline that applies to other single-purpose patterns in a properly organised instrument tray.

Corrosion on the clips themselves is nearly always a water quality problem rather than a steel problem. Chloride-heavy rinse water leaves deposits that pit austenitic stainless during the drying phase.

Sourcing note

When specifying michel skin clips, state the clip size and pack quantity separately from the forceps pattern and length — they are two different line items and are frequently confused on purchase orders. Confirm the forceps is supplied as a genuine double-ended applying/removing pattern rather than an applying-only version, and ask for the steel grade in writing. Fizza Surgical manufactures both the clips and the forceps in Sialkot under ISO 13485, and the full range sits within our general surgical instruments catalogue. Certification documents are available on our certifications page.