Skin Staple Use Parameters for Wound Closure
Skin staples should be used selectively for wound closure, with subcuticular continuous sutures being preferred for most abdominal surgeries due to lower rates of surgical site infections (SSI) and wound dehiscence. 1, 2
Advantages and Disadvantages of Skin Staples
Advantages:
- Speed of application: Staples can be applied 5-6 times faster than conventional sutures (22.5 cm/min vs 4.2 cm/min) 3
- Reduced surgical time: Can save an average of three minutes per wound, with greater time savings for longer incisions 3
- Reduced needle-stick risk: No risk of accidental needle-stick injury to healthcare providers 4
- Potential infection resistance: Some evidence suggests clean-contaminated wounds closed with staples may have greater resistance to infections than suture-closed wounds 5
Disadvantages:
- Higher inflammation rates: Higher incidence of inflammation compared to nylon sutures 6
- Patient discomfort: More discomfort during removal compared to sutures 6
- Cosmetic concerns: Greater risk of "railroad track" scarring and spreading of the healing scar 6, 2
- Higher SSI risk in some surgeries: Higher incidence of SSI in hepato-pancreatobiliary surgery compared to subcuticular continuous sutures (10.0% vs 1.8%) 1
Optimal Use Parameters
Best Anatomical Locations:
- Highly recommended for: Scalp wounds (ideal location, no postoperative dressing required) 7, 4
- Acceptable for: Long linear abdominal incisions when speed is prioritized 3
- Less ideal for: Facial wounds in young people (where fine closure with silk or nylon may provide superior cosmetic results) 7
Timing of Staple Removal:
- Standard timing: 7-10 days after placement 2
- Extended timing: Consider longer retention (beyond 10 days) for:
- Patients with impaired healing (diabetes, immunosuppression, corticosteroid use)
- Nutritional deficiencies
- Advanced age
- Higher tension areas 2
Post-Removal Considerations:
- Evaluate for proper healing before removal (well-approximated wound edges, absence of infection) 2
- Consider steri-strips for additional support after staple removal, though they do not reduce SSI rates 1, 2
- Keep the wound hydrated and protected from sun exposure for at least 6 months for proper healing 2
Complications to Monitor
- Early removal risks: Wound dehiscence if removed before adequate healing
- Late removal risks: "Railroad track" scarring or tissue overgrowth around staples
- Infection signs: Erythema >5cm or purulent discharge require immediate attention 2
Special Considerations
- Contaminated wounds: Consider delayed primary closure with a second look and closure between 2-5 days postoperatively 2
- High-risk patients: Those with factors that impair wound healing should have longer retention of staples 2
- Cost considerations: Staples cost slightly more than sutures (approximately 50p more per 15 cm wound), but time savings may offset costs 3
Alternative Closure Methods
When staples are not ideal, consider: