Is it recommended to staple a head laceration?

Stapling Head Lacerations

Yes, staples are an excellent option for head laceration closure, particularly for scalp wounds, as they are faster to apply, less painful for patients, and have comparable outcomes to sutures in terms of infection rates and wound healing. 1, 2

Advantages of Staples for Head Lacerations

• Speed of application: Stapling is significantly faster than suturing, which is particularly beneficial in busy emergency settings 1, 3
• Reduced pain: Studies show stapling is less painful than traditional suturing 1
• Safety for providers: Eliminates risk of accidental needle-stick injuries 1
• Comparable outcomes: Similar morbidity and infection rates to sutures 1

Best Practices for Stapling Head Lacerations

Appropriate Wound Selection

• Best for linear lacerations of the scalp 2
• Less appropriate for:
  • Facial lacerations (use sutures instead) 2
  • Areas over joints or high mobility 2
  • Hands and feet 2

Preparation and Technique

1. Wound preparation:

   • Clean the wound with betadine or chlorhexidine 4
   • Irrigate vigorously if the wound is deep, dirty, or may contain foreign bodies 2
   • If hair removal is necessary, clip rather than shave to reduce infection risk 5
   • Avoid incorporating hair into the staple line as this increases infection risk 5

2. Anesthesia options:

   • Topical anesthetics
   • Local infiltration
   • Regional blocks 2

3. Stapling technique:

   • Ensure wound edges are properly aligned
   • Place staples approximately 5mm apart
   • Maintain even tension across the wound

Wound Care After Stapling

• Cleaning: Gently clean daily with mild soap and warm water 5
• Dressing: Cover with clean, dry dressing until wound has sealed (usually 2-3 days) 5
• Protection: Protect the healing wound from trauma; avoid strenuous activities for 1 week 5
• Staple removal: Remove scalp staples after 7-10 days

Follow-up and Monitoring

• Schedule follow-up for staple removal and wound assessment
• Monitor for signs of infection:
  • Increasing redness, warmth, or swelling
  • Red streaking extending from the wound
  • Increasing pain beyond expected
  • Purulent or foul-smelling drainage 5

Alternative Closure Methods

While staples are excellent for scalp lacerations, other options include:

• Sutures: Preferred for facial lacerations and areas requiring precise cosmetic results 2
• Tissue adhesives: Good option for low-tension areas; associated with shorter ED length of stay compared to both sutures and staples 3, 6
• Hair apposition technique: Effective for certain scalp lacerations 6

Potential Pitfalls and Caveats

• Avoid stapling facial lacerations due to cosmetic concerns
• Ensure proper wound cleaning and preparation before closure
• Consider patient factors (age, cooperation level) when selecting closure method
• Be aware that scalp wounds can bleed profusely due to rich vascularity 7

Staples represent an efficient, effective method for closing head lacerations, particularly in the scalp region, with outcomes comparable to traditional suturing but with significant advantages in terms of application speed and patient comfort.