Is it safe to prolong the use of a skin stapler in a patient with a non-healing wound?

Prolonged Skin Stapler Use in Non-Healing Wounds

No, skin staplers should not be left in place beyond the standard removal timeframe of 7-14 days, even if the wound has not fully healed, due to increased risk of inflammation, patient discomfort, and scar spreading. 1

Standard Staple Removal Timeline

Staples must be removed within the appropriate timeframe based on anatomical location:

• Scalp wounds: Remove at 7-10 days 2
• Trunk and extremity wounds: Remove at 10-14 days 2, 1
• High-tension areas: Maximum 14 days regardless of healing status 3

The evidence consistently demonstrates that prolonged staple retention beyond these timeframes causes more harm than benefit, with significantly higher rates of inflammation, discomfort during removal, and adverse scarring compared to sutures 1.

Risks of Prolonged Staple Retention

Leaving staples in place beyond the recommended timeframe creates specific complications:

• Increased inflammation at staple sites occurs with extended retention 1
• Significant discomfort on removal when staplers remain beyond standard timeframes 1
• Spreading and widening of healing scars develops with prolonged staple use 1
• Risk of staple track marks and permanent cosmetic deformity increases 1

These complications occur because staples create focal points of tension and foreign body reaction that worsen over time, unlike continuous subcuticular sutures that distribute tension evenly 4.

Management of Non-Healing Wounds After Staple Removal

When wounds have not adequately healed at the time of scheduled staple removal, the correct approach is:

1. Remove the staples on schedule (7-14 days depending on location) to prevent the complications listed above 3, 1

2. Immediately apply Steri-Strips for continued wound support after staple removal 3:

   • Facial wounds: 5-7 days of Steri-Strip application 3
   • Body wounds: 10-14 days, with high-tension areas requiring the full 14 days 3
   • Keep completely dry for 24-48 hours after application 3

3. Consider resuturing with continuous subcuticular technique using slowly absorbable monofilament sutures (4-0 poliglecaprone or polyglactin) if significant wound dehiscence is present, as this technique reduces superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted closure methods 4, 5

4. Use triclosan-coated antimicrobial sutures if infection is present or suspected, as they significantly reduce surgical site infection risk (OR 0.72; 95% CI 0.59-0.88) 4, 5

Critical Pitfalls to Avoid

Common errors in managing wounds with delayed healing:

• Never leave staples in place "just a few more days" hoping for better healing—the inflammation and scarring complications outweigh any theoretical benefit 1
• Do not apply ointments, creams, or lotions over or near Steri-Strips after staple removal, as these loosen the adhesive and compromise wound support 3
• Avoid premature Steri-Strip removal (before 10-14 days for body wounds), as this risks wound dehiscence due to inadequate tensile strength development 3
• Do not ignore signs of infection (increasing pain, redness, swelling, warmth, or discharge) that may be contributing to delayed healing 3

When to Escalate Care

Immediate evaluation is required if:

• Wound edges are separating despite appropriate closure technique 3
• Fever, chills, or red streaks extending from the wound develop 3
• Pus, cloudy drainage, or foul odor appears 3
• Pain increases after the first 2-3 days rather than improving 3
• Significant wound dehiscence occurs requiring surgical revision 5

Evidence Quality Note

The only advantage of staples over sutures is speed of initial wound closure 1, 6. However, this time-saving benefit (approximately 80% faster application) 6 does not justify prolonged retention when wounds fail to heal appropriately. The higher complication rates with extended staple use, particularly inflammation and scarring, make timely removal mandatory regardless of healing status 1.