Introduction: Understanding Suture Clips and Clamps in Modern Surgery
Surgeons face a persistent challenge in wound closure: speed versus cosmetic outcomes. Traditional metal staples close incisions quickly but often leave visible scarring and require painful removal. Manual suturing provides superior aesthetics but adds 5-10 minutes per closure—time that accumulates across high-volume surgical practices.
Mechanical closure devices have emerged to bridge this gap, combining rapid application with improved patient outcomes.
This guide covers what suture clips and clamps are, when surgical teams use them, and the clinical criteria for selecting the right closure method for your procedures.
TLDR: Key Takeaways About Suture Clips and Clamps
- Reduce closure time by 5-9 minutes per procedure vs. hand-tied sutures
- Two main types: non-absorbable metal (requires removal) or bioabsorbable polymers (body absorbs)
- Selection based on wound tension, location, cosmetic goals, and efficiency needs
- Subcuticular bioabsorbable systems deliver stapler speed with better cosmetics—no external skin piercing
What Are Suture Clips and Clamps?
Suture clips are mechanical fastening devices that bring wound edges together using metal or polymer materials, serving as alternatives to traditional needle-and-thread sutures. These devices compress or grip tissue to hold wound edges together during healing, eliminating the need for manual threading.
The basic mechanism varies by device type:
- Clips compress tissue between two legs that bend into a B-shape configuration, securing tissue layers while allowing blood flow
- Clamps provide temporary or permanent closure through gripping mechanisms, from hemostatic clips that seal blood vessels to temporary tissue approximation instruments
Historical Development:
Mechanical tissue approximation has evolved significantly since its inception:
- 1908: Hungarian surgeon Hültl developed the first surgical stapler (8 pounds, two rows of staples)
- 1950s: Soviet scientists advanced the technology at Moscow's Scientific Research Institute for Experimental Surgical Apparatus and Instruments
- 1958: American surgeon Mark Ravitch introduced these instruments to the West, refining them into linear and circular staplers
- Late 20th century: Introduction of powered staplers and bioabsorbable materials (copolymers of polylactide and polyglycolide)
- 2021: FDA reclassified surgical staplers for internal use from Class I to Class II due to device malfunction reports
This evolution led to today's sophisticated closure systems that prioritize both speed and tissue compatibility.
Key Components:
Modern clip and clamp systems consist of three main elements:
- Delivery device - The applicator or stapler that houses and deploys the fasteners
- Fastener design - The clip or staple configuration that engages tissue
- Tissue interaction mechanics - How the device compresses, grips, or holds tissue edges together
Terminology Clarification:
- Skin clips - Surface closure devices for external wound approximation
- Deep tissue clamps - Internal hemostatic or ligating clips for vessel occlusion
- Suture anchoring clips - Specialized devices for securing suture material
Types of Suture Clips and Clamps
Traditional Metal Skin Clips and Staples
Metal clips made from stainless steel (typically 316L) or titanium provide rapid skin approximation in high-volume surgical settings. The devices compress tissue between a cartridge and anvil, with staple legs penetrating the epidermis and dermis before bending against the anvil to secure closure.
Mechanism and Application:
Traditional metal staples pierce the skin surface, creating visible entry and exit points. This delivers closure speeds of approximately 52.7 seconds for an average incision compared to 478.5 seconds for sutures.
However, percutaneous placement can result in characteristic "train track" scarring when staples remain in place too long or are applied too tightly.
Removal Requirements:
Metal clips must be extracted 7-14 days post-surgery using specialized removal tools. Clinical guidelines recommend removal at day 7 for scalp wounds, while trunk and extremity wounds may require 7-14 days depending on tension. Staple removal can be more painful than suture removal, with patients experiencing discomfort and anxiety about the removal procedure.
Bioabsorbable and Absorbable Clips
Polymer-based clips represent a significant advancement in closure technology. These devices degrade naturally over weeks to months through hydrolysis.
Common bioabsorbable materials include:
- Polylactic acid (PLA)
- Polyglycolic acid (PGA)
- Polydioxanone (PDO)
- Poly(lactic-co-glycolic acid) (PLGA) copolymers
Advantages of Bioabsorbable Technology:
- Elimination of removal procedures and associated patient discomfort
- Reduced patient anxiety about follow-up appointments
- No permanent foreign body retention
- Superior cosmetic outcomes compared to metal staples
- Reduced infection risk from elimination of removal procedure
Absorbable polymeric clips are typically absorbed within 90-180 days depending on the specific material formulation and placement location. Studies indicate that absorbable subcuticular staples provide cosmetic results equivalent to sutures while being faster to apply.
SubQ It! Bioabsorbable Skin Closure System:
One example of this bioabsorbable technology in practice is SubQ It!, a subcuticular closure solution that combines the speed of mechanical stapling with bioabsorbable fastener technology. Unlike traditional staples that pierce the external skin, SubQ It! places fasteners entirely subcutaneously through a specialized deployment mechanism.
The system delivers closures 7X faster than manual sutures (7 seconds per fastener versus 42 seconds per stitch) while eliminating both train track scarring and removal procedures.
The bioabsorbable fasteners are made from PLGA, maintaining 80% of their tensile strength for 21 days before being naturally absorbed by the body.
Each fastener weighs only 0.0064 grams and uses barbed legs that engage tissue 3-4mm back from the wound edge, avoiding the local ischemia caused by traditional staples that tightly compress tissue at the incision line.
Specialized Surgical Clamps
Hemostatic/Ligating Clips:
Ligating clips provide permanent or temporary occlusion of blood vessels and tubular structures such as the cystic duct during cholecystectomy.
Available in both titanium (e.g., Ligaclip, Horizon) and polymer formulations (e.g., Hem-o-lok made from non-absorbable acetyl polymer), clips range from Medium (2-7mm tissue bundles) to Extra-Large (7-16mm tissue bundles).
Imaging Compatibility:
Polymer clips are radiolucent and don't interfere with CT or MRI imaging. Titanium clips are generally MR Conditional (safe up to 3.0 Tesla) but may create susceptibility artifacts that compromise image quality near the clip site.
Tissue Approximation Clamps:
Temporary instruments hold tissues in position during procedures while permanent closure methods are applied, facilitating precise alignment before final closure.
Comparison Table
| Clip Type | Material | Typical Applications | Removal Required | Absorption Timeline | Key Advantages |
|---|---|---|---|---|---|
| Metal Staples | Stainless steel, Titanium | Emergency trauma, orthopedic closures | Yes (7-14 days) | N/A | Fastest closure time, consistent tension |
| Bioabsorbable Clips | PLGA, PLA, PGA, PDO | Cosmetically sensitive areas, general surgery | No | 90-180 days | No removal needed, superior cosmetics |
| SubQ It! Subcuticular | PLGA | Laparoscopic, abdominal, gynecologic, plastic surgery | No | Absorbed after healing | 7X faster than sutures, no external skin piercing, no train track scars |
| Hemostatic Clips | Titanium or Polymer | Vessel ligation, duct occlusion | No | N/A (permanent) | Precise vessel control, small profile |
Clinical Applications: When Suture Clips Are Used
Emergency and Trauma Surgery
Speed is critical in emergency settings where rapid closure can save lives. Staples are the preferred method for scalp and extremity lacerations in emergency departments, enabling faster patient turnover in trauma bays. In mass casualty scenarios, mechanical closure devices allow surgical teams to treat more patients efficiently while maintaining adequate wound approximation.
Abdominal Surgery
Common applications in laparoscopic and open procedures include:
- Cesarean sections - Though staples carry a 4-fold increased risk of wound separation compared to subcuticular sutures, they save approximately 7 minutes of operative time
- Appendectomies - Mechanical closure saves approximately 9 minutes with no significant difference in complications compared to ligatures
- Hernia repairs - Clips expedite closure of multiple tissue layers in both laparoscopic and open approaches
- Laparoscopic procedures - Trocar site closures particularly benefit from bioabsorbable subcuticular systems like SubQ It!, which close small incisions without piercing external skin
Orthopedic Procedures
Clips provide consistent wound edge approximation for closing surgical incisions over joints and high-tension areas. Meta-analyses show a significantly higher risk of superficial wound infection with staples in hip surgery, though no significant difference appears in knee surgery.
Despite infection concerns, the time savings remain substantial, with staples reducing closure time by approximately 5.84 minutes in orthopedic applications.
Plastic and Reconstructive Surgery
In cosmetically sensitive areas, surgeons are shifting from traditional metal clips to bioabsorbable alternatives. A study on breast reconstruction found that epidermal staples resulted in significantly better scar scores (2.0 vs. 3.4) when removed early.
Bioabsorbable subcuticular systems eliminate the timing concerns entirely by never piercing the external skin.
Specialty-Specific Considerations
- Thoracic surgery - Pleural closure and chest wall incision management
- Gynecologic surgery - Episiotomy repair, hysterectomy closures, and cesarean deliveries
- Cardiovascular procedures - Vein harvest site closure following bypass grafting
Advantages and Limitations of Suture Clips
Primary Advantages
Dramatic Time Savings:
Studies consistently show 5-9 minute reductions in closure time compared to hand-tied sutures. Some procedures demonstrate even more impressive results, with staples being 4-5 times faster than suturing.
This efficiency directly reduces anesthesia exposure time and improves operating room throughput.
Consistent Tension Application:
Mechanical staplers apply uniform closure force and staple height, which reduces tissue ischemia caused by overly tight manual sutures. This consistency helps standardize outcomes across different surgeon skill levels.
Reduced Surgeon Fatigue:
By automating the repetitive motion of closure, mechanical devices reduce physical strain on surgeons, particularly beneficial during lengthy procedures or high-volume surgical days.
Lower Infection Risk:
Shorter operative times correlate with reduced infection risk, though this relationship varies by procedure type and device selection.
Cosmetic and Patient Comfort Considerations
While speed and consistency offer clear advantages, the patient experience and cosmetic outcomes vary significantly between device types.
Metal Staples:
- Cause visible "train track" scarring when left too long
- Require painful removal procedures 7-14 days post-surgery
- Create patient anxiety about removal appointments
- May result in higher post-operative physician visits
Bioabsorbable Alternatives:
- Eliminate removal-related discomfort and anxiety
- Provide superior cosmetic outcomes through subcutaneous placement
- Higher upfront material costs offset by elimination of removal visit expenses
- Reduce total healthcare system costs when accounting for the entire episode of care
Systems like SubQ It! combine the speed of mechanical closure with bioabsorbable fasteners placed subcutaneously, eliminating both staple removal visits and train track scarring.
Limitations
Anatomical Restrictions:
Clips may be unsuitable for certain locations requiring precise edge eversion, such as facial closures, hand surgery, or areas where meticulous cosmetic outcomes are paramount.
Complication Profiles:
Staples may increase adverse events by two times compared to sutures—showing 7.3% vs 3.5% complication rates in some procedures. In cesarean sections specifically, staples show significantly higher wound separation rates.
Device-Specific Concerns:
- Potential for clip migration if not sized or applied correctly
- Metal clips can obscure anatomy in post-operative imaging
- Learning curve for proper application technique
- Higher upfront costs than traditional suture material
Selection Criteria: Choosing the Right Suture Clip or Clamp
Wound Characteristics
Incision Length and Location:
- Short incisions (<10cm) - Consider specialized devices like SubQ It! SU-10 designed for laparoscopic trocar sites
- Longer incisions (10-25cm) - SubQ It! SU-25 or traditional stapling systems
- High-tension areas (scalp, back) - Metal staples or retention sutures for maximum strength
- Cosmetically sensitive areas (face, visible skin) - Bioabsorbable subcuticular systems or fine sutures
Tissue Thickness and Tension:
- High-tension wounds - Devices providing stronger tissue engagement (metal staples, retention sutures)
- Low-tension areas - Cosmetically refined options (bioabsorbable systems, subcuticular sutures)
- Thick tissue - Longer fastener penetration depth required
- Thin or fragile skin - Gentler closure methods to prevent tearing
Patient Factors
Age and Healing Capacity:
Pediatric patients heal faster and may tolerate earlier staple removal for improved cosmesis. Elderly patients with thinner skin may require gentler closure methods.
Comorbidities:
- Diabetes - Higher infection and dehiscence risk; bioabsorbable options may reduce complications compared to metal staples
- Obesity - Increased wound separation risk with staples; subcuticular sutures or bioabsorbable systems preferred
- Immunosuppression - Consider devices that minimize infection pathways
Lifestyle and Activity Level:
Active patients work well with closure methods that eliminate removal appointments. Bioabsorbable systems provide secure healing without activity restrictions during recovery.
Cosmetic Concerns:
For patients prioritizing minimal scarring, bioabsorbable subcuticular systems offer optimal outcomes by combining rapid closure with superior aesthetic results.
Beyond patient-specific factors, practical considerations around surgical workflow and facility constraints also guide device selection.
Procedural Efficiency Requirements
Surgical Volume:
High-volume practices see the greatest impact from time savings. Reducing closure time by 9 minutes per case significantly impacts daily surgical capacity.
Operating Room Constraints:
When OR time represents a primary cost driver, the upfront expense of mechanical devices offsets facility costs. Calculate the cost per minute of OR time in your facility to determine break-even points.
Staff Training:
Consider the learning curve and training requirements. Devices like SubQ It! demonstrate near-perfect performance with basic training, while more complex systems may require extensive practice.
Cost-Benefit Analysis
Total Episode Costs:
While metal staples have higher upfront costs than sutures, analyze the complete care pathway:
- Device acquisition cost
- OR time savings (valued at facility-specific rates)
- Removal appointment costs (staff time, scheduling, facility use)
- Complication management expenses
- Patient satisfaction and experience factors
Decision Framework
Match device selection to your specific clinical scenario:
For cosmetically sensitive areas: Bioabsorbable subcuticular systems provide rapid closure while minimizing visible scarring through subcutaneous fastener placement.
For high-volume surgical practices: Mechanical closure devices reduce procedure time significantly—some bioabsorbable systems close 7X faster than manual sutures while eliminating follow-up removal visits.
For patients prioritizing convenience: Systems that don't require removal appointments improve patient experience and reduce healthcare system burden.
When evaluating specific devices, verify regulatory clearances match your intended surgical applications and ensure quality certifications (such as ISO 13485) guarantee consistent manufacturing standards.
Frequently Asked Questions
What is a suture clip?
A suture clip is a mechanical device that holds wound edges together as an alternative to traditional sewn sutures. Available in metal or bioabsorbable materials, these clips compress tissue to approximate wound edges during healing.
Why use suture clips instead of stitches?
Clips reduce closure time by up to 7X compared to manual sutures while providing consistent tension across the wound. This speed advantage is ideal for lengthy procedures and high-volume surgical settings.
Are suture clips dissolvable?
Traditional metal clips require removal 7-14 days post-surgery. Modern bioabsorbable clips made from polymers like PLGA naturally degrade over several weeks to months, eliminating removal procedures.
How are suture clips removed?
Metal clips are removed using a specialized tool that bends the clip to release tissue, typically 7-14 days post-surgery. Bioabsorbable clips require no removal as they dissolve naturally.
What are the main types of suture clips and clamps?
Main types include metal skin staples for rapid surface closure, bioabsorbable polymer clips that eliminate removal, hemostatic clips for vessel ligation, and temporary clamps for tissue positioning during procedures.
When should surgeons choose clips over traditional sutures?
Choose clips when speed is essential, for long incisions, or in high-tension areas requiring consistent approximation. Bioabsorbable subcuticular systems like SubQ It! are particularly advantageous for laparoscopic procedures and cosmetically sensitive areas.
