Introduction
Wound closure decisions directly impact patient outcomes, operative efficiency, and complication rates. Surgical staples are widely used across general surgery, orthopedics, plastic surgery, and gynecology as a rapid method for closing wounds and creating tissue connections.
However, surgical teams struggle with balancing speed against cosmetic outcomes and patient comfort. Metal staples require proper selection based on tissue thickness, correct placement technique, and appropriate removal timing to avoid complications like wound separation or infection.
Specialized bioabsorbable subcuticular closure systems are gaining traction, particularly in obstetrics and plastic surgery where scar minimization is critical. These systems combine the speed of traditional staplers with superior cosmetic outcomes.
This guide provides operational guidance for surgical teams on proper staple placement, monitoring, and removal in clinical practice, not just theoretical applications. Understanding when to use metal staples versus alternative closure methods directly impacts patient comfort, healing quality, and healthcare costs.
TL;DR
- Titanium or stainless steel staples rapidly close external skin wounds
- Successful closure depends on matching staple size to tissue thickness
- Removal timing varies by location: 5-7 days (scalp/face) to 10-14 days (extremities)
- Specialized removal tools prevent wound reopening and tissue damage
- Bioabsorbable subcuticular systems match staple speed without removal needs
When Should You Use Surgical Staples?
Surgical staples work best for linear wounds under low tension, particularly on the scalp, trunk, and extremities where cosmetic outcomes are less critical.
They excel in situations requiring rapid closure with consistent tension distribution.
Ideal Applications:
- Clean, easily approximated wound edges
- Scalp closures following craniotomy
- Abdominal incisions after laparotomy
- Orthopedic incisions over extremities
- Emergency trauma settings requiring rapid hemorrhage control
Internal Stapler Applications
Beyond external skin closure, internal staplers serve specialized purposes in complex procedures:
- Gastrointestinal anastomoses (connecting bowel segments)
- Lung resections and thoracic procedures
- Bariatric surgery requiring secure tissue connections
These devices create tissue connections faster than hand-sewn techniques while maintaining standardized compression.
When Staples Are Inappropriate:
Avoid metal staples in these situations:
- Facial areas, hands, or neck requiring fine cosmetic closure
- Irregular wounds with jagged or uneven edges
- Areas under high tension without deep supporting sutures
- Patients with known metal allergies
- Locations where removal access will be difficult
Contraindications:
- Infected wounds or contaminated sites
- Areas with poor blood supply (compromised perfusion)
- Patients with keloid tendencies in cosmetically sensitive areas
- Thin, fragile skin (elderly patients, chronic steroid users)
What You Need Before Using Surgical Staples
Required Equipment:
- Skin stapler for external closure or linear cutter/circular stapler for internal procedures
- Correct staple size and cartridge based on manufacturer guidelines for tissue compatibility
- Sterile field with cleaned, debrided wound and achieved hemostasis
- Tissue forceps or skin hooks for proper wound edge approximation
Operator Requirements:
Beyond equipment, successful stapling requires specific operator competencies:
- Training in stapler use and tissue handling principles (proper technique reduces complications)
- Adequate visualization and tissue access before device deployment
- Verification that surrounding structures (vessels, nerves, adjacent organs) are clear of the staple line
Research indicates that trained operators achieve faster closure times and fewer complications compared to those without formal instruction.
How to Use Surgical Staples (Step-by-Step)
Surgical stapling follows a specific sequence from wound preparation through final inspection. Skipping steps commonly leads to malformed staples, wound dehiscence, or infection.
Wound Preparation and Assessment
Before placing the first staple, complete these preparation steps:
- Achieve hemostasis — Active bleeding prevents proper staple formation and increases hematoma risk
- Assess wound edges — Confirm tissue viability and adequate tissue for approximation without excessive tension
- Debride nonviable tissue — Remove any compromised tissue that could impair healing
- Irrigate thoroughly — Cleanse the wound according to surgical protocol
Positioning and Aligning the Stapler
Use tissue forceps or skin hooks to evert wound edges slightly, ensuring dermal-to-dermal contact. Position the stapler perpendicular to the wound line with the center mark aligned over the wound midpoint. Maintain consistent distance between staples (typically 0.5-1 cm apart for skin closure) to balance security with tissue perfusion.
Deploying the Staples
With the stapler properly positioned:
- Apply gentle, even pressure to approximate wound edges
- Squeeze the trigger in one smooth, complete motion
- Listen for the characteristic "click" confirming complete staple formation
- Keep the stapler perpendicular throughout deployment — angling creates uneven staple legs
Incomplete deployment results in malformed staples that must be removed immediately.
Inspecting Staple Formation
Check each staple immediately after placement:
- Proper formation — Staple should show rectangular or "B-shape" with both legs penetrating evenly
- Tension assessment — Wound edges approximated without gaps, overlapping, or tissue blanching
- Malformation identification — One leg not penetrating, staple too tight/loose, or incomplete closure
Remove and replace any malformed staples immediately.
Post-Placement Wound Care
Apply appropriate dressing based on wound location and drainage expectations. Document staple count, wound characteristics, and any complications in the operative or procedure note. Provide clear instructions for staple care timeline and removal schedule based on anatomical location.
Where Surgical Staples Are Commonly Used in Practice
External Applications:
Surgeons commonly use staples for scalp closures following craniotomy, where high vascularity allows rapid healing. Abdominal incisions after laparotomy and orthopedic incisions over extremities represent the most common external stapling sites.
Internal Stapler Use:
Gastrointestinal surgery relies heavily on staplers for bowel anastomoses and resections. Thoracic surgeons use staplers for lung tissue sealing, while bariatric procedures depend on staplers for gastric division and bypass creation.
These applications vary by surgical specialty, with distinct patterns emerging across different fields.
Specialty-Specific Patterns:
General surgeons favor staplers for speed in abdominal closures, achieving closure times of 2-4 minutes versus 8-9 minutes with sutures. Plastic surgeons typically avoid metal staples for aesthetic procedures.
However, bioabsorbable subcuticular systems gain acceptance due to their elimination of "railroad track" scarring. These systems offer:
- Speed comparable to traditional staplers
- Superior cosmetic outcomes
- Elimination of staple removal procedures
- Reduced patient discomfort during healing
Emergency and trauma settings often prefer staples for time-critical closures. When every minute counts during hemorrhage control, the speed advantage of staples can be lifesaving.
Best Practices for Using Surgical Staples Effectively
Effective wound closure requires balancing speed, security, and patient outcomes. Traditional metal staples offer rapid closure but require removal and can cause scarring. Modern bioabsorbable systems provide an alternative approach.
Key Closure Considerations:
When selecting a closure method, surgical teams should evaluate:
- Tissue thickness and tension at the incision site
- Patient healing capacity and follow-up access
- Desired cosmetic outcome and scarring potential
- Time constraints in the operating room
- Post-operative care requirements
The Bioabsorbable Advantage:
Bioabsorbable subcuticular closure systems eliminate removal requirements while providing comparable closure speed—particularly valuable for patients with removal access challenges or anxiety about staple removal.
Research in cesarean sections demonstrated 2.6-minute closure times versus 8.5 minutes for sutures. The systems eliminate follow-up removal visits entirely.
SubQ It! offers this technology with FDA clearance for abdominal, thoracic, gynecologic, orthopedic, plastic, and reconstructive surgery. The bioabsorbable dermal fasteners are inserted subcutaneously—the external skin is never pierced—and absorb naturally after healing, eliminating train track scarring.
Conclusion
Effective surgical stapling depends on proper technique, appropriate patient selection, and disciplined adherence to placement and removal protocols. While staplers offer significant time savings—reducing closure times by 50-70% compared to manual suturing—they are not universally superior to sutures.
The key is matching closure method to clinical context.
Metal staples excel in emergency settings, high-volume procedures, and anatomical locations where cosmetic appearance is less critical. However, bioabsorbable subcuticular systems like SubQ It! now provide surgeons with alternatives that combine stapler speed with superior cosmetic outcomes and elimination of removal procedures.
As closure technology continues to evolve, surgical teams should prioritize selecting techniques that optimize patient outcomes, reduce complications, and improve workflow efficiency for their specific applications.
Frequently Asked Questions
How long do surgical staples usually stay in?
External skin staples typically remain 5-10 days depending on wound location: scalp/face 5-7 days, trunk 7-10 days, extremities 10-14 days. Timing adjusts based on patient healing factors like age and wound tension.
Why do surgeons use staples instead of stitches?
Staples offer significantly faster application time (2-4 minutes versus 8-9 minutes for sutures) and provide consistent tension distribution with less tissue trauma. Sutures remain preferred for areas requiring fine cosmetic results like the face and hands.
Is it painful to have surgical staples removed?
Removal typically causes brief discomfort (pinching/pulling sensation) but is generally well-tolerated. Patients with anxiety may receive local anesthetic or pain medication beforehand.
What are surgical staples made out?
Most surgical staples are made from titanium (preferred for MRI safety) or stainless steel. Newer bioabsorbable options use PLGA polymer that dissolves naturally, eliminating removal procedures while maintaining strength for 21 days.
Can I have an MRI with surgical staples?
Titanium staples are MRI-safe and cause minimal imaging artifacts, while stainless steel staples may cause more distortion but are generally safe. Bioabsorbable polymer staples contain no metal and create no MRI artifacts.
Can you shower with staples in the abdomen?
Most patients can shower 24-48 hours after staple placement once initial dressings are removed. Avoid submerging wounds in water (baths, pools, hot tubs) and always follow your surgical team's specific guidance.
