Are skin staples as effective as sutures for wound closure, and do they result in longer healing time?

Staples vs. Sutures for Wound Closure

Sutures are generally superior to staples for wound closure, particularly subcuticular continuous sutures, which reduce wound dehiscence without increasing infection rates or healing time. However, staples offer significantly faster closure times and may be appropriate in specific clinical contexts where speed is prioritized.

Key Evidence-Based Recommendations

Wound Dehiscence and Infection Outcomes

The most critical finding from guideline evidence shows that subcuticular continuous sutures significantly reduce superficial wound dehiscence compared to interrupted sutures or staples (RR 0.08; 95% CI 0.02 to 0.35) 1. This represents a substantial reduction in wound breakdown without compromising healing time.

Regarding surgical site infections (SSI):

• No significant difference exists between continuous sutures and interrupted techniques for SSI rates (RR 0.73; 95% CI 0.40 to 1.33) 1
• One Japanese study showed subcuticular continuous sutures had dramatically lower SSI rates (1.8%) compared to stapling (10.0%, P < 0.01) in hepato-pancreatobiliary surgery, though this was a single-institution retrospective study 1

Healing Time

There is no evidence that staples result in longer healing time compared to sutures 1. The guideline evidence demonstrates no significant differences in length of hospital stay between closure methods. The key advantage of continuous subcuticular sutures is the retained tensile strength (50-75% at 1 week) from absorbable materials like poliglecaprone or polyglactin, which provides extended wound support and explains the reduced dehiscence rates 1.

Practical Considerations

Closure Speed:

• Staples are dramatically faster: mean closure time 3-5 minutes versus 12-34 minutes for sutures 2, 3, 4, 5
• The slowest staple closure is typically 4 times faster than the fastest suture closure 2

Pain and Patient Comfort:

• Pain during removal is generally less with staples (VAS 3.15) compared to sutures (VAS 5.08) 2
• Postoperative pain at day 3 shows no significant difference between methods 6

Cosmetic Outcomes:

• Initial appearance (day 10) may favor sutures
• Long-term cosmetic results (6 months) are comparable or may favor staples 3, 5
• Patient satisfaction scores are equivalent between methods 6

Clinical Algorithm for Decision-Making

Choose Subcuticular Continuous Sutures When:

• Wound dehiscence risk is a primary concern
• Patient has risk factors for poor wound healing (obesity, diabetes, immunosuppression)
• Cosmetic outcome is particularly important
• Time is not a critical constraint
• Performing abdominal, groin, or clean surgical procedures

Choose Staples When:

• Operative time reduction is critical (trauma, lengthy procedures)
• Multiple wounds require closure
• Cost of extended operative time exceeds material cost
• Patient will have reliable follow-up for removal
• Performing neck dissections or orthopedic procedures where speed matters

Avoid Both (Consider Tissue Adhesives or No Closure) When:

• First-degree lacerations that are hemostatic
• Minimal tension wounds
• Patient preference for no removal procedure
• Note: Tissue adhesives have higher dehiscence rates (RR 3.35) compared to sutures 1

Important Caveats

1. Quality of Evidence Limitation: The guideline explicitly states "high grade of uncertainty remains" due to study quality issues 1. Many studies comparing staples versus sutures used interrupted rather than continuous subcuticular techniques, confounding direct comparisons.

2. Suture Material Matters: The benefits of continuous sutures specifically apply to absorbable subcuticular materials (4-0 poliglecaprone or polyglactin), not transcutaneous interrupted sutures that require removal 1.

3. Population-Specific Data: Most high-quality RCTs included children/adolescents undergoing appendectomy, limiting generalizability to all surgical populations 1.

4. Cost Considerations: Staples cost approximately 5 times more than sutures as materials 2, but this must be weighed against reduced operative time and associated costs.

5. Steri-Strips Add No Value: Adding adhesive strips to either closure method does not improve outcomes or reduce complications 1.

Bottom Line for Practice

For most elective surgical procedures, use subcuticular continuous sutures with absorbable material (4-0 poliglecaprone or polyglactin) to minimize wound dehiscence risk 1. Reserve staples for situations where operative time is critical or when performing procedures where research specifically supports their use (certain neck or orthopedic surgeries). The healing time is equivalent between methods, so this should not factor into your decision-making 1, 6.