TLDR
- Deploys metal or bioabsorbable staples in under one second for rapid wound closure
- Transforms flat staples into box shapes that approximate and evert skin edges
- Used for surgical incisions, laceration repair, and time-critical procedures
- Minimizes infection, dehiscence, and scarring with proper technique and patient selection
- Bioabsorbable systems like SubQ It! eliminate removal and visible scarring
What Is a Skin Stapler?
In operating rooms worldwide, surgeons face a consistent challenge: closing wounds quickly without compromising cosmetic outcomes. Traditional suturing requires manual needle threading, multiple knot ties, and significant time investment.
Skin staplers offer a solution. These handheld surgical instruments mechanically deploy individual staples to close skin wounds by penetrating both wound edges. They reduce closure time by 75-80% while maintaining comparable security and cosmetic outcomes.
Modern options extend beyond traditional metal staples. Subcuticular staplers place fasteners under (not through) the skin surface, offering superior cosmetic results and eliminating the need for removal.
Main Types:
- Disposable single-use staplers: Pre-loaded with 35 staples in sterile packaging (most common)
- Reusable multi-fire staplers: Feature reloadable cartridges for up to 12 firings in high-volume centers
- Wide-crown staplers: Built for edematous tissue and high-tension areas (~6.5mm crown)
- Bioabsorbable subcuticular staplers: Place fasteners subcutaneously, eliminating removal procedures
How Does a Skin Stapler Work?
Skin staplers operate through a precisely engineered four-stage mechanical sequence that transforms a flat staple into a secure box-shaped wound closure in under one second.
Loading and Positioning
Modern disposable staplers come pre-loaded with sterile staples made from 316L stainless steel or titanium. Typical specifications include:
- Wire diameter: 0.5mm
- Crown span: 5.7-6.5mm
- Leg length: 3.5-4.7mm
The surgeon aligns the stapler's anvil head perpendicular to the wound, ensuring both wound edges are everted and brought together beneath the device. Proper skin eversion and alignment at this stage determine final closure quality.
Many devices include visual guides or rotating heads for precise placement.
Staple Deployment and Penetration
Squeezing the handle drives the staple former downward, forcing the rectangular staple through both wound edges simultaneously. The staple legs pierce through the epidermis and dermis on both sides of the wound, engaging tissue at two distinct points approximately 6-10mm apart.
Deployment occurs in approximately 8.3 seconds per centimeter of wound, compared to 63.2 seconds per centimeter for suturing—making staplers roughly 7-8 times faster than traditional methods.
Staple Formation and Closure
As staple legs penetrate and reach the anvil surface, they encounter shaped grooves that bend the legs inward and upward, transforming the rectangular staple into a box or "B" configuration.
This box shape creates consistent tissue apposition with slight eversion (favorable for healing) while avoiding excessive compression that could compromise blood flow.
The formed staple maintains tissue perfusion by avoiding the "pinch and clamp" effect that causes local ischemia. The box configuration distributes tension evenly across the wound edges, promoting optimal healing conditions.
Staple Release and Finalisation
Once formation is complete, releasing handle pressure allows the stapler mechanism to retract, leaving the formed staple embedded in the tissue. Properly placed staples should sit with:
- Crown flush or slightly above skin surface
- Legs fully formed into box shape
- Minimal blanching of surrounding tissue
Surgeons visually assess each staple for proper formation, adequate spacing (typically 5-10mm between staples), and secure tissue approximation before moving to the next placement.
Clinical Indications and Applications
Skin staplers are indicated for linear wound closure in anatomical locations with adequate tissue thickness (>4.5mm from underlying structures) and minimal tension. They're used across emergency, elective, and trauma surgery settings.
Primary Surgical Applications
Core surgical uses include:
- Closure of clean surgical incisions in abdominal surgery
- Orthopaedic procedures (total knee arthroplasty, hip replacement)
- Thoracic surgery incisions
- Caesarean sections
- Scalp wounds following neurosurgical procedures
Staplers excel in these contexts because large incisions (>10cm) benefit from speed. In total knee arthroplasty, staples reduce closure time by 30-40%, potentially saving an estimated $10,000 per case in operative time costs (assuming $30/minute OR costs).
This time savings translates to measurable cost reductions and improved operating room efficiency.
Staplers perform best on relatively flat surfaces with skin thickness >4.5mm from underlying bone, vessels, or viscera—making them ideal for the scalp, trunk, and extremities.
Emergency and Trauma Settings
Beyond planned surgical procedures, staplers offer significant advantages in time-critical situations.
Emergency indications:
- Laceration repair in emergency departments where rapid closure minimises sedation requirements
- Paediatric scalp lacerations (closure in 65 seconds vs. 397 seconds for sutures)
- Trauma situations requiring rapid temporary closure in damage-control surgery
- Mass casualty situations where speed is critical for survival
In paediatric scalp lacerations, stapling is not only 6 times faster but also costs less ($23.55 vs. $38.51 total cost) with no difference in pain or complications.
Specialty and Emerging Applications
While traditionally favored for speed over cosmetics, newer techniques and bioabsorbable options are expanding cosmetic applications. Innovative uses include:
- Skin graft attachment
- Wound dressing securement
- Belt-loop gastropexy procedures
Bioabsorbable subcuticular staplers like SubQ It! represent an emerging option that combines stapler speed with superior cosmetic outcomes. These devices place fasteners subcutaneously rather than through the skin, eliminating visible puncture marks and removal procedures.
SubQ It! offers distinct advantages for cosmetically sensitive closures:
- Deploys fasteners in 7 seconds each—7 times faster than manual subcuticular sutures
- Completely avoids external skin penetration that causes "train track" scarring
- Eliminates staple removal appointments and associated patient discomfort
- Absorbed naturally by the body after healing
Key Safety Tips and Best Practices
While skin staplers are generally safe when used appropriately, adherence to proper technique, patient selection criteria, and safety protocols minimises complications and optimises outcomes.
Patient Selection and Contraindications
Absolute contraindications include:
- Areas with thin skin over bone, vessels, or internal organs
- Wounds under significant tension
- Infected or contaminated wounds
- Patients with known metal allergies (for metal staples)
Relative contraindications include:
- Areas requiring fine cosmetic outcomes (face, hands)
- Patients with bleeding disorders
- Areas subject to frequent movement or tension
When to choose sutures instead:
- Anatomical location demands superior cosmetic results
- Wound characteristics include irregular edges or significant tension
- Patient factors such as metal allergy or keloid history
Proper Placement Technique
Once appropriate patients are selected, proper stapler technique becomes critical to achieving optimal outcomes.
Critical steps include:
- Ensure wound edges are evenly approximated and slightly everted before deployment
- Maintain perpendicular orientation to skin surface
- Achieve consistent spacing (5-10mm between staples)
- Assess each staple for proper formation before proceeding
Common technical errors to avoid:
- Placing staples on non-everted edges (leads to inversion and poor scarring)
- Angling the stapler (causes incomplete formation)
- Spacing too close (<5mm) or too far (>10mm), affecting closure integrity
Improper technique can double adverse event risks. Studies show adverse events occur in 7.3% of stapled wounds versus 3.5% with sutures when technique is suboptimal.
Infection Prevention and Wound Care
Sterile technique requirements:
- Use sterile disposable staplers or properly sterilised reusable devices
- Appropriate skin preparation and draping
- Maintain aseptic technique throughout deployment
Post-placement care:
- Keep staple line clean and dry
- Monitor for signs of infection (erythema, drainage, dehiscence)
- Follow appropriate timing for staple removal
Infection rates vary across studies. Some research found no significant difference between staples and sutures, while other studies report 6.75% infection rates for staples versus 4.90% for sutures. Proper technique and patient selection are critical factors in infection prevention.
Removal Best Practices
Proper removal technique involves:
- Use dedicated staple remover tool that deforms staple into "M" shape for atraumatic extraction
- Remove alternate staples first if wound appears healed
- Never use improvised tools
Timing considerations by location:
- Facial wounds: 5-7 days
- Scalp/trunk: 7-10 days
- Extremities: 10-14 days
Premature removal risks dehiscence, while delayed removal increases scarring and removal difficulty. Staple removal is generally more painful than suture removal, with VAS pain scores typically around 3 for staples vs. 1 for sutures. Consider topical anaesthetic for anxious patients or children.
Complication Recognition and Management
Potential complications include:
- Staple rotation or dislodgement
- Wound infection
- Dehiscence
- Excessive scarring ("train track" marks)
- Allergic reactions to metal
Early warning signs requiring intervention:
- Increasing pain, redness, or swelling
- Purulent drainage
- Wound separation
- Staple loosening
Early recognition allows for timely staple removal and wound reassessment. Some complications may require staple removal and conversion to alternative closure methods.
Frequently Asked Questions
What is a skin stapler?
A skin stapler is a handheld medical device that rapidly closes wounds by deploying metal or bioabsorbable staples through the skin edges. These standard tools are used throughout operating rooms and emergency departments worldwide.
Is it painful to remove skin staples?
Most patients experience only brief discomfort during removal, described as a quick pinching or pulling sensation, with proper removal technique using a dedicated staple remover minimizing discomfort.
Can you be allergic to surgical staples?
While rare, allergic reactions to metal staples (typically nickel allergy) can occur, causing local inflammation, itching, or rash. Patients with known metal allergies should inform their surgeon, who may choose titanium staples or bioabsorbable alternatives.
What material are skin staples made of?
Most skin staples are made from 316L stainless steel or titanium (both generally biocompatible and MRI-safe). Newer bioabsorbable staples are made from synthetic polymers like polyglycolic acid (PLGA) that dissolve naturally over time, eliminating the need for removal procedures.
Are surgical staples MRI safe?
Both stainless steel and titanium surgical staples are classified as MR Conditional and are safe to scan under specific conditions (static magnetic field of 3.0 Tesla or less). They may cause minor imaging artifacts (signal voids), with titanium producing fewer artifacts. Inform MRI technicians about any surgical hardware.
How long should skin staples stay in before removal?
Timing varies by anatomical location: facial wounds 5-7 days, scalp and trunk 7-10 days, extremities and areas under tension 10-14 days. The surgeon determines optimal timing based on wound healing progress and individual patient factors. Premature removal risks dehiscence, while delayed removal increases scarring.
Considering alternatives to traditional metal staples? SubQ It! offers bioabsorbable subcuticular staplers that deliver 7X faster closure than manual sutures while eliminating visible scarring and removal procedures. The FDA-cleared system places fasteners entirely subcutaneously, never piercing the external skin. Contact our team at +1 339-933-8811 or sales@subq-it.com to learn more about SubQ It! for your surgical practice.
