Introduction
Wound closure is one of the last steps in surgery — but it's rarely a minor decision. The choice between metal staples, sutures, and bioabsorbable systems touches every metric that matters to surgical teams and hospital administrators alike:
- Cosmetic outcomes and scarring risk
- Infection rates and recovery timelines
- OR time and procedural efficiency
- Staple removal scheduling and associated costs
Bioabsorbable closure systems eliminate several of these tradeoffs entirely — no percutaneous staples, no removal appointments, no train-track scarring. This guide breaks down what bioabsorbable wound closure actually involves, how these devices compare, and what to evaluate before selecting one for your practice or facility.
TL;DR
- Bioabsorbable staple applicators close incisions subcutaneously using fasteners that dissolve naturally — no removal visit required
- Subcuticular closure can run up to 7x faster than manual sutures while delivering superior cosmetic outcomes
- Key selection factors: absorption timeline, tensile strength, FDA clearance, ease of use, and total cost of care
- Cleared for abdominal, thoracic, gynecologic, orthopedic, and plastic/reconstructive procedures
- Eliminating staple removal visits reduces per-case cost, often offsetting the higher device price
What Are Biodegradable Staple Applicators?
Biodegradable (bioabsorbable) staple applicators are surgical closure devices that insert fasteners subcutaneously, which are then naturally absorbed by the body during healing. Unlike traditional metal staplers, bioabsorbable systems never pierce external skin and eliminate the need for a removal procedure.
Two main categories exist:
- Single-use disposable applicators — pre-loaded with bioabsorbable fasteners and discarded after use
- Reloadable systems — accept cartridge refills for repeated use in the same procedure
The terms "biodegradable" and "bioabsorbable" carry a technical distinction: bioabsorbable materials are assimilated by cells and tissue through intended degradation, while biodegradable materials break down through broader biological activity. For regulatory classification, the FDA uses the term "absorbable."
Core Components of Bioabsorbable Wound-Closure Systems
Three components drive the clinical performance of any bioabsorbable wound-closure system: the fastener material, the applicator mechanism, and the fastener configuration.
Bioabsorbable Fastener Material
Common materials include polydioxanone (PDO), polyglycolic acid (PGA), and poly(lactic-co-glycolic acid) (PLGA). Material composition affects absorption rate, tensile strength retention, and tissue reaction.
Material characteristics:
- PDO retains 50–60% tensile strength at 4 weeks and fully absorbs in approximately 180 days
- PGA maintains 65% strength at 2 weeks, dropping to 35% by week 3, with absorption in 60–90 days
- PLGA offers tunable degradation — adjusting the lactide-to-glycolide ratio controls resorption rate, with roughly half the mass gone by 10 weeks
These polymers degrade primarily through hydrolysis, breaking down into metabolic byproducts like lactic acid and glycolic acid that the body eliminates through normal metabolic pathways.
Applicator Mechanism
Applicator design directly affects how precisely and quickly fasteners are placed subcutaneously. Key ergonomic features to evaluate include:
- Ridged grip surfaces for stable one-handed control
- Trigger mechanisms that regulate deployment force
- Safety systems that prevent accidental activation before use
Modern applicators include automatic needle retraction mechanisms that eliminate needle stick injury risk while maintaining surgical precision.
Fastener Configuration
Fastener shape, size, and insertion depth influence wound approximation quality, healing outcomes, and cosmetic results. Bioabsorbable fasteners feature barbed configurations that engage dermal tissue below the skin surface, distributing tension more evenly than surface-level staples or sutures.
The subcutaneous placement means external skin is never pierced, eliminating the "train track" scarring pattern common with percutaneous metal staples.
Benefits of Bioabsorbable Staple Applicators
Bioabsorbable staple applicators deliver measurable gains across four areas: cosmetic outcomes, patient experience, OR efficiency, and infection risk.
Superior Cosmetic Outcomes
Subcuticular placement eliminates "train track" scarring common with percutaneous metal staples. In plastic surgery applications such as abdominal donor sites for breast reconstruction, epidermal staples demonstrated statistically superior aesthetic outcomes compared to sutures across multiple validated metrics including surface area, thickness, and overall opinion (P < 0.05).
For cesarean sections, randomized trials show absorbable subcuticular staples yield cosmetic outcomes comparable to subcuticular sutures, with no significant difference in patient or observer scar assessment scores.
Elimination of Removal Procedures
Patients avoid the discomfort, anxiety, and scheduling burden of staple removal appointments. Hospitals eliminate associated labor and resource costs — a straightforward win for both sides of the care equation.
Faster Closure Times
Research shows bioabsorbable systems can close incisions significantly faster than manual suturing. A randomized trial demonstrated a median closure time of 2.6 minutes for subcuticular staples versus 8.5 minutes for sutures (P < 0.001) in cesarean sections. In plastic and reconstructive procedures, absorbable staples were 7-fold faster than sutures for dermal closure.
With OR costs estimated between $36 and $46 per minute, saving 5-6 minutes per case translates to direct savings of approximately $180-$276 per procedure in OR time opportunity costs.
Reduced Infection Risk
Subcuticular placement generally shows lower infection rates than percutaneous methods. In cesarean deliveries, absorbable subcuticular staples were associated with significantly fewer composite wound complications (0% vs. 14.3% for traditional staples).
A meta-analysis of abdominal surgery found no significant difference in surgical site infection rates between subcuticular sutures and staples — suggesting that subcuticular placement itself may matter more than the specific closure device used.
What to Consider When Choosing a Bioabsorbable Staple Applicator
Evaluating a bioabsorbable staple applicator means looking beyond the device itself — the right choice connects clinical performance, operational fit, and total cost to the specific needs of your practice and patient population. These six criteria give surgical teams and procurement decision-makers a framework for assessing total value, not just sticker price.
FDA Clearance and Regulatory Compliance
FDA 510(k) clearance matters for liability protection, reimbursement eligibility, and evidence of safety/efficacy. Check for specific surgical indication clearances relevant to your practice—some devices are cleared for abdominal, thoracic, gynecologic, orthopedic, and plastic surgery, while others have narrower indications.
ISO 13485 certification indicates the manufacturer follows quality management standards for medical device production.
Absorption Timeline and Tensile Strength Retention
Once regulatory standing is confirmed, the next question is clinical performance — specifically, how the device holds up during healing. The critical window for wound support is the first 1–4 weeks, so the gap between strength retention and full absorption must match the tissue type you're closing.
Key considerations:
- Maintains adequate tensile strength for 7–21 days during the active healing phase
- Fully absorbs between 60–180 days, with no removal required
- High-tension areas or patients with delayed healing need fasteners with longer strength retention
If a polymer degrades too quickly, dehiscence can occur. PLGA staples showed higher dehiscence incidence in peripheral vascular surgery due to insufficient strength retention during post-operative edema, highlighting the importance of matching material to application.
Ease of Use and Learning Curve
Applicator design, tactile feedback during deployment, and training time all affect adoption rates and consistency across surgical teams. Most teams reach proficiency within 3–5 uses, and leading manufacturers support this with hands-on training, video tutorials, and proctoring.
Effective technique centers on proper device positioning and skin eversion — fasteners must deploy strictly within the dermis, never piercing the epidermis. Teams new to subcuticular systems should confirm training resources are included before committing.
Incision Length Capacity and Fastener Count
Matching device capacity to typical incision lengths in your practice matters. Devices typically come in configurations handling 10-25 cm incisions. Consider the trade-off between single-applicator convenience and cost-efficiency for smaller closures.
Smaller-capacity devices (10 fasteners) work well for laparoscopic trocar incisions, while higher-capacity models (25 fasteners) suit longer open procedures.
Cost-Effectiveness and Total Cost of Ownership
Calculate beyond device purchase price to include eliminated staple removal visits, reduced OR time value, and potential reduction in complication-related costs.
Total cost components:
- Device unit cost runs higher than traditional staples or sutures
- OR time savings of 5–6 minutes per closure at $36–46/minute add up quickly
- Eliminated removal visits cut staff time, supply use, and scheduling overhead
- Fewer complications mean lower downstream costs across the episode of care
A budget impact analysis estimated that reducing post-operative visits and dressing changes could save a hospital $28,349 to $39,809 annually per 500 procedures. Surgical site infections can increase total costs by 3- to 4-fold, making infection prevention a major factor in the total cost equation.
Cosmetic Outcome Evidence and Patient Satisfaction Data
Review published studies or manufacturer-provided data on scarring scores and patient-reported outcomes. Two validated assessment scales are worth knowing:
- Vancouver Scar Scale (VSS) — clinician-rated assessment covering vascularity, pigmentation, pliability, and height
- Patient and Observer Scar Assessment Scale (POSAS) — captures both clinician and patient perspectives, useful for documenting patient-reported cosmesis
Patients consistently report high satisfaction with bioabsorbable closures, especially when they learn no removal visit is needed — a detail worth communicating during pre-operative counseling.
How SubQ It! Can Help
SubQ It! is the only FDA-cleared bioabsorbable subcuticular skin closure system that combines stapler speed with superior cosmetic outcomes — purpose-built for the OR time pressure, scarring concerns, and patient comfort issues surgical teams navigate every day.
Key differentiators:
- FDA 510(k) cleared (K131563) for abdominal, thoracic, gynecologic, orthopedic, plastic, and reconstructive surgery
- ISO 13485 certified for quality management
- Closes incisions 7X faster than sutures — 7 seconds per fastener vs. 42 seconds per stitch
- Eliminates all external skin piercing through subcutaneous placement
- No removal required: fasteners absorb naturally after healing
- Reduces "train track" scarring through dermal placement
- Lowers total cost of care by eliminating removal visits and reducing OR time
Both models ship pre-loaded with bioabsorbable PLGA fasteners and share the same core design: automatic needle retraction for safety and ergonomic grip for precise deployment.
| Model | Incision Length | Best For |
|---|---|---|
| SU-10 | Up to 10 cm | Laparoscopic and small open incisions |
| SU-25 | Up to 25 cm | Larger open surgical incisions |
Fasteners in both models maintain 80% tensile strength for 21 days, covering the critical early healing window.
Conclusion
Selecting a bioabsorbable staple applicator means evaluating the full clinical and economic picture — surgical volume, patient population, cosmetic outcome priorities, and operational efficiency all factor into the right fit.
Before committing to a system, work through these practical checkpoints:
- Absorption timeline — does it align with your typical wound healing window?
- Learning curve — can your team realistically integrate it without disrupting OR flow?
- Total cost of ownership — factor in eliminated removal visits and reduced closure time, not just device price
- Pilot data — run the system in controlled cases, gather surgeon and patient feedback, and track complication rates before full adoption
Systems like SubQ It! — which place fasteners subcutaneously and absorb after healing — are worth evaluating against these criteria, particularly for teams prioritizing cosmetic outcomes and eliminating the staple-removal appointment entirely.
Frequently Asked Questions
How long does it take for bioabsorbable staples to fully absorb?
Absorption timelines vary by material composition, typically requiring 60-180 days to fully break down — PDO at approximately 180 days, PGA and PLGA at 60-90 days. For clinical purposes, tensile strength retention during the first 7-21 days of healing is a more useful performance benchmark than total absorption time.
Are bioabsorbable staple applicators more expensive than traditional metal staplers?
Yes, upfront costs are higher than traditional staplers or sutures. Total cost of ownership often proves lower, though — eliminating staple removal visits saves $28,000-40,000 annually per 500 procedures, and reduced OR time saves $180-276 per case, with additional savings from fewer wound complications.
What types of surgeries are best suited for bioabsorbable staple applicators?
FDA-cleared indications include abdominal, thoracic, gynecologic, orthopedic, and plastic/reconstructive surgeries. They offer particular value in cosmetically sensitive areas and laparoscopic procedures — cesarean sections, breast reconstruction, and hernia repairs are among the most common applications.
Do bioabsorbable staples provide the same tensile strength as metal staples?
Modern bioabsorbable fasteners provide adequate tensile strength during the critical healing period (7-21 days), with clinical studies demonstrating comparable wound dehiscence rates when properly applied. Material selection matters: PLGA fasteners showed higher dehiscence in high-tension vascular closures, so matching device to tissue type and tension requirements is essential.
What are the infection rates with bioabsorbable vs. traditional staples?
Subcuticular placement generally shows lower infection rates than percutaneous methods. One cesarean delivery study found 0% composite wound complications with absorbable subcuticular staples versus 14.3% with traditional metal staples, suggesting placement depth may matter as much as device type.
How much training is required to use bioabsorbable staple applicators?
Most surgical teams reach proficiency within 3-5 uses. Manufacturers typically provide hands-on training with surrogate skin materials, video tutorials, and proctored support — with the learning curve centered on device positioning and correct skin eversion for subcutaneous placement.
