Introduction
A surgeon stands at the operating table, scalpel set aside, ready to close a 12-centimeter abdominal incision. The decision seems straightforward—stitches or staples—but the implications ripple far beyond this single moment. This choice directly impacts how quickly the patient heals, whether visible scarring remains, the level of post-operative discomfort, and even the total cost of care including follow-up removal visits.
The stakes are substantial. In 2021, approximately 11.9 million ambulatory surgery encounters took place across the United States, each requiring some form of wound closure.
The FDA's 2021 reclassification of surgical staplers from Class I to Class II devices reflects growing safety concerns. This change was prompted by over 41,000 adverse event reports between 2011 and 2018, including 366 deaths. Closure method selection demands careful clinical judgment, not habit.
TL;DR
- Stitches provide precision multi-layer closure with superior cosmetic results for facial wounds
- Staples apply 3-4X faster on scalp/extremity wounds but risk "train track" scarring
- Wound location, depth, tension, cosmetics, and time drive closure selection
- Bioabsorbable subcuticular systems deliver 7X faster closure with minimal scarring—no removal needed
Stitches vs Staples: Quick Comparison
| Factor | Stitches (Sutures) | Staples |
|---|---|---|
| Application Speed | 3-5 minutes per inch | 1-2 minutes per inch |
| Material Options | Silk, nylon, polypropylene, absorbable polymers | Titanium, stainless steel, limited absorbable options |
| Removal Method | Scissors or self-absorbing | Special removal tool required |
| Scarring Potential | Minimal with proper technique | "Train track" marks possible |
| Best Use Cases | Face, hands, layered closures | Scalp, back, high-tension areas |
| Cost Profile | Lower material cost ($10-30), longer OR time | Higher device cost ($50-150), faster application, removal visit expense |
What Are Stitches (Sutures)?
Surgical sutures are sterile threads used to bring wound edges together (approximate), available in both absorbable and non-absorbable materials. Common options include silk, nylon, polypropylene, and synthetic polymers like polyglycolic acid and polylactic acid.
This versatility allows surgeons to close wounds across multiple tissue layers—subcutaneous (below skin), dermal (within skin), and epidermal (skin surface)—using various techniques including simple interrupted, running, and subcuticular methods.
The precision of sutures enables exact wound edge alignment, which is critical for optimal healing. When placed subcuticularly (beneath the skin surface), sutures reduce tension on the visible skin layer and minimize foreign body reaction.
This approach delivers superior cosmetic outcomes, particularly on highly visible areas like the face and hands. These advantages make sutures the preferred choice for complex closures requiring meticulous technique.
Core Benefits and Applications
Sutures excel in complex wound closures requiring multiple layers. The subcuticular technique places sutures below the visible surface, virtually eliminating visible scarring—a crucial advantage for facial wounds, hand surgery, and plastic or reconstructive procedures where cosmetic outcome is paramount.
Research shows that properly placed sutures demonstrate comparable or lower infection rates than other closure methods. The range of absorbable sutures further enhances convenience:
- Polyglactin 910 (Vicryl) – Loses 50% strength in 3 weeks, absorbed in 70 days
- Poliglecaprone 25 (Monocryl) – Ideal for subcuticular closure, loses 50% strength at 1 week, absorbed in 120 days
- Polydioxanone (PDS II) – Retains 50% strength at 4 weeks, absorbed in 180 days
These absorbable options eliminate removal visits entirely, addressing a significant patient convenience and cost factor.
Key limitations of sutures:
- Application time averages 3-5 minutes per linear inch
- Requires skilled technique for optimal cosmetic results
- Potential for suture reaction in sensitive patients
- More time-intensive than mechanical closure methods
What Are Staples?
Surgical staples are metal fasteners—typically titanium or stainless steel—that rapidly bring wound edges together using a specialized stapling device. The staples are pre-loaded in disposable staplers that crimp each fastener through both wound edges.
Common staple materials include:
- Titanium—biocompatible and MRI-safe, most widely used
- Stainless steel—offers greater strength but carries nickel sensitivity risks
- Bioabsorbable polymers—newer alternative that eliminates removal needs (like SubQ It!'s technology)
Each fastener creates an inverted "B" or "M" shape to hold tissue together.
The FDA's 2021 reclassification from Class I to Class II devices followed analysis of over 41,000 medical device reports between January 2011 and March 2018, including 366 deaths, over 9,000 serious injuries, and more than 32,000 malfunctions.
This regulatory shift now requires manufacturers to submit premarket notifications and meet mandatory special controls.
Core Benefits and Applications
Staples deliver a dramatic speed advantage: application averages 0.8 minutes per centimeter versus 3.5 minutes per centimeter for sutures—approximately 3-4 times faster. This makes them ideal for lengthy incisions or time-sensitive procedures where operating room efficiency is critical.
They work best in high-tension areas like the scalp, back, and extremities where thick skin requires rapid, strong closure without concern for train-track scarring. Common surgical applications include:
- Orthopedic procedures
- Cesarean sections
- Abdominal surgeries
- Trauma cases requiring rapid closure
Key considerations:
- Require removal tools and follow-up visit (7-14 days)
- Create visible "train-track" scarring, especially with late removal
- May cause patient anxiety during removal
- Unsuitable for facial or cosmetic closure areas
- Cost $50-150 per stapler vs. $10-30 for sutures
- Show 57% higher infection odds in lower extremity bypass
Timely removal is critical to prevent permanent scarring. Guidelines recommend removal within 7-10 days for the scalp, 7 days for trunk and upper extremities, and 8-10 days for lower extremities.
Stitches vs Staples: Which Is Better for Your Surgical Procedure?
The choice between stitches and staples isn't one-size-fits-all. The optimal method depends on wound characteristics (location, depth, tension, length), patient factors (skin type, healing capacity, cosmetic concerns), surgical context (time constraints, complexity), and surgeon experience.
Choose stitches when:
- Closing facial wounds or hand injuries
- Cosmetic outcome is the primary concern
- Working with pediatric patients
- Multiple tissue layers require closure
- Precise wound edge approximation is essential
Choose staples when:
- Closing scalp lacerations
- Managing long linear incisions on trunk or extremities
- High-tension closures are needed
- Surgical time efficiency is critical
- Cosmetic scarring is less concerning
Anatomical Considerations
Location significantly influences closure method selection. The face and hands demand sutures for cosmetic reasons, while the scalp and back tolerate staples well.
Areas over joints need careful consideration of tension and movement to prevent wound separation.
Patient comfort varies by method. Staple application involves fewer punctures initially, but removal can provoke anxiety. Sutures placed under the skin surface (subcuticular) eliminate removal trauma entirely, improving the overall patient experience.
Research demonstrates equivalent healing times and infection rates between properly applied stitches and staples. Main differences appear in cosmetic appearance and patient satisfaction. Staples show approximately two-fold higher risk of adverse events including wound separation compared to sutures in systematic reviews.
Modern Alternatives: The Evolution of Wound Closure Technology
Emerging technologies aim to combine the benefits of both traditional methods while eliminating their drawbacks.
Modern options include tissue adhesives, adhesive strips, and bioabsorbable subcuticular closure systems—the newest generation of wound closure solutions.
Traditional methods carry inherent limitations:
- Sutures consume significant surgical time
- Staples cause train-track scarring and require removal
- Both methods pierce the skin surface, creating potential infection pathways
These limitations have driven innovation in subcuticular closure technology.
Bioabsorbable Subcuticular Closure Systems
SubQ It! Bioabsorbable Skin Closure System delivers subcuticular closure with stapler-like speed—7X faster than manual sutures—while eliminating train-track scarring by never piercing external skin. The bioabsorbable fasteners require no removal as they are naturally absorbed during healing.
The technology employs bioabsorbable dermal fasteners (made from PLGA material) placed subcutaneously using a disposable stapler device. This combines rapid application similar to staples with superior cosmetic outcomes similar to subcuticular sutures.
The system is particularly beneficial for laparoscopic and small incisions in abdominal, thoracic, gynecologic, orthopedic, and plastic/reconstructive surgery.
Clinical and economic advantages include:
- Reduces closure time from 9 minutes (manual sutures) to approximately 4 minutes
- Eliminates follow-up removal visits and associated costs
- Minimizes scarring for improved patient satisfaction
- Meets FDA 510(k) clearance requirements (K131563) and ISO 13485 quality standards
- Fasteners maintain 80% strength for 21 days before natural absorption
- Each fastener weighs only 0.0064 grams
The subcutaneous placement engages tissue relatively far from the cut edge, avoiding the pinching and clamping that causes local ischemia (reduced blood flow) with traditional staplers.
This approach potentially provides improved healing outcomes and lower infection risk compared to surface-piercing methods.
Conclusion
The choice between stitches and staples should be guided by wound-specific factors, surgical goals, and patient priorities rather than a one-size-fits-all approach.
Both methods offer proven efficacy when properly applied, with distinct advantages in different clinical contexts.
When evaluating closure methods, consider the full treatment cycle:
- Application time and procedural efficiency
- Healing outcomes and complication rates
- Cosmetic results and scarring potential
- Removal requirements and patient discomfort
- Total healthcare costs (application plus removal)
Traditional sutures provide superior cosmetic results but require more time. Staples offer speed but necessitate removal and risk train-track scarring. Bioabsorbable subcuticular systems like SubQ It! address limitations of both approaches by combining stapler-like speed with subcutaneous placement that eliminates removal visits and minimizes visible scarring.
These innovations deliver the efficiency surgical teams need with the comfort and aesthetic outcomes patients expect.
Frequently Asked Questions
Is it better to get stitches or staples?
The optimal choice depends on wound location, size, and cosmetic importance. Stitches work best for facial wounds requiring precise closure, while staples suit scalp and high-tension areas. Bioabsorbable systems like SubQ It! now combine the speed of staples with superior cosmetic outcomes.
Can I ask for stitches instead of staples?
You can discuss preferences with your surgeon, but the final decision should prioritize clinical factors like wound characteristics and optimal healing. Your surgeon's expertise will determine the most appropriate closure method for your specific case.
What type of wound requires staples?
Surgeons typically use staples for long linear incisions on the scalp, back, arms, legs, and high-tension areas where speed is important and cosmetic scarring is less concerning. Avoid using them on the face, hands, or areas requiring precise cosmetic closure.
How long do stitches and staples stay in place?
Facial sutures typically remain 3-5 days, body sutures 7-14 days, and staples 7-14 days depending on location. Absorbable sutures dissolve naturally over 60-90 days, eliminating removal visits entirely.
What are the signs of infection in a surgical wound?
Key infection indicators include increased redness, warmth, swelling, purulent drainage, foul odor, fever, and increasing pain. Seek immediate medical attention if these symptoms develop, regardless of closure method used, as prompt treatment prevents serious complications.
