Surgical staples are specialized medical devices, typically made of titanium, stainless steel, or plastic, used to close skin wounds or internal tissue during surgery. They function by physically approximating the edges of an incision or laceration, holding the tissue together until natural healing occurs. The use of staples is one of several wound closure techniques available to clinicians, alongside traditional sutures (stitches) and tissue adhesives (medical glue). The choice among these options depends entirely on the specific characteristics of the wound and the patient’s overall condition.
Factors Influencing the Decision to Use Staples
A primary consideration for selecting staples is the need for rapid wound closure, particularly in emergency or high-volume surgical settings. Staples can be applied significantly faster than conventional sutures—up to five or six times quicker—which reduces the overall time a patient spends under anesthesia. This efficiency is especially valuable for closing very long linear incisions, where time savings are substantial.
Staples are highly effective at managing wounds under significant tension, such as those following major orthopedic or abdominal surgeries. The rigid, metallic structure provides a strong, uniform closure that can withstand pulling forces across the wound edges better than some superficial suturing techniques. This mechanical strength ensures the wound remains securely closed, preventing the incision from opening up (dehiscence).
The closure method also minimizes the risk of accidental needle-stick injury to surgical staff, as the stapler device automates the process. Furthermore, staples offer a minimal tissue reaction compared to some suture materials. In certain clean-contaminated wounds, they may exhibit a greater resistance to infection because they pierce the skin at discrete points, creating less foreign material within the wound itself.
Common External Wound Applications
Staples are highly recommended for incisions on the scalp due to the underlying firm bone structure. Scalp wounds are often under high tension and difficult to close with fine sutures, making the speed and strength of staples a considerable advantage. Staples in this area often do not require a post-operative dressing.
Staples are frequently employed for long, linear incisions on the torso or extremities following major procedures like hip or knee replacement or extensive abdominal surgery. Closing these large surgical wounds requires both speed and reliable strength to ensure tissue layers remain approximated. This application prioritizes functional closure and operating room efficiency over fine cosmetic results.
In trauma situations where a patient may be unstable or have multiple injuries, the speed of stapling is a major benefit for closing extensive lacerations quickly and effectively. Disposable skin staplers are also used in some flap and graft surgeries to secure the donor skin to the recipient site. They help maintain even tension across the graft, which is important for promoting successful healing and integration.
Situations Where Staples Are Avoided
Staples are generally avoided in areas where the cosmetic outcome is a primary concern, such as the face, neck, and chest. The mechanical placement of staples tends to leave small, parallel marks, sometimes referred to as a “railroad track” scar. This is less aesthetically pleasing than the fine line achieved by meticulous suturing. For these cosmetically sensitive locations, absorbable subcuticular sutures or tissue adhesives are often the preferred methods.
Wounds located over areas of high mobility, including the hands, feet, and joints like the elbow or knee, are also less suitable for staple closure. Constant movement in these regions can cause the skin to pull against the rigid staples, leading to patient discomfort and a higher risk of the staples migrating or tearing the skin. Sutures allow for more flexible and detailed closure that accommodates the natural movement of the joint.
Staples are not the ideal choice for small, irregular, or jagged lacerations, which require precise alignment of the wound edges to heal properly. These types of wounds are best managed with fine sutures or tissue adhesives, which allow for a more detailed closure. Staples are best reserved for clean, straight, surgical incisions or large traumatic wounds where the benefits of speed and strength outweigh the cosmetic drawbacks.