From the Research
Staples should not be used for head lacerations in several specific situations, including facial lacerations, scalp areas with thin skin, stellate or irregular lacerations, wounds with significant tissue loss, contaminated wounds, or lacerations over bony prominences. When considering the use of staples for head lacerations, it is essential to prioritize the patient's morbidity, mortality, and quality of life. The most recent and highest quality study 1 compared the effectiveness of suturing, stapling, and hair apposition techniques for scalp lacerations and found that hair apposition technique had the advantages of being more satisfying and having lower cosmetic problem and complication rates. However, staples can be used for linear lacerations in hair-bearing areas of the scalp where the cosmetic result is less visible, as they provide rapid wound closure and are less painful 2. Key contraindications for stapling head lacerations include:
- Facial lacerations or complex wounds where traditional suturing techniques remain the preferred approach for optimal cosmetic and functional outcomes
- Scalp areas with thin skin, such as over the temple
- Stellate or irregular lacerations
- Wounds with significant tissue loss
- Contaminated wounds
- Lacerations over bony prominences where the staples may cause pressure necrosis
- Patients with known nickel allergies, as most staples contain nickel
- Areas where cosmetic outcome is particularly important
- Patients who cannot return for staple removal
- Patients with bleeding disorders or on anticoagulation therapy where hemostasis may be difficult to achieve. It is crucial to weigh the benefits and risks of stapling head lacerations and consider alternative methods, such as suturing or hair apposition techniques, to ensure the best possible outcome for the patient.