Cover image for Skin Staplers (Staple Guns) for Wound Closure: Types, Indications, and Selection Checklist

Introduction

Choosing the right skin stapler affects more than just closure speed. Traditional metal staplers leave visible scarring, require painful removal appointments, and add follow-up costs—complications that impact both patient satisfaction and surgical workflow efficiency.

Newer bioabsorbable stapling systems now eliminate removal procedures entirely while delivering cosmetic outcomes comparable to manual sutures. The challenge is understanding when each technology fits best.

This guide covers the two main stapler categories (metal vs. bioabsorbable), their clinical indications across surgical specialties, and a practical selection checklist for matching device features to procedure requirements.

TLDR

  • Skin staplers close wounds 3-7X faster than traditional sutures using metal or bioabsorbable fasteners
  • Choose from three types: traditional metal, powered, or bioabsorbable subcuticular
  • Selection depends on wound location, cosmetic priorities, and patient follow-up reliability
  • Bioabsorbable staplers eliminate removal visits and reduce visible scarring

What Is a Skin Stapler?

A skin stapler is a handheld surgical instrument that places metal or bioabsorbable fasteners across wound edges to achieve rapid skin closure.

Surgeons primarily use these devices for external wound closure—closing the skin surface after surgery or trauma—as opposed to internal surgical staplers used for organ anastomosis during procedures like bowel resection.

Understanding the terminology matters. While patients and families often search for "surgical staple gun," medical professionals prefer "skin stapler" or "surgical stapler" to reduce anxiety. Despite the hardware-inspired name, these devices are precision medical instruments designed specifically for surgical applications.

Why Are Skin Staplers Important in Wound Closure?

Staplers significantly reduce closure time compared to sutures. Research shows staplers close wounds approximately 5-7 minutes faster than sutures, which is critical in trauma, emergency, and high-volume surgical settings.

In one randomized controlled trial, mean closure time was 4.8 minutes for staples versus 12 minutes for sutures.

Consistent staple placement reduces variability in wound closure quality. When used appropriately and removed on time, staplers can streamline surgical workflows and reduce surgeon fatigue during long procedures.

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Without efficient closure methods, several complications arise:

Common challenges include:

  • Prolonged operative time increases anesthesia exposure and patient risk
  • Wound edge misalignment can compromise healing
  • Surgeon fatigue during lengthy closures may affect precision
  • Delayed closure in trauma settings can worsen outcomes

The speed advantage comes with trade-offs. Meta-analyses indicate significantly higher surgical site infection (SSI) risk in hip arthroplasty when staples are used (relative risk 2.05 compared to sutures).

Cosmetic outcomes may be inferior if staples remain in place too long.

Types of Skin Staplers

Skin staplers are not one-size-fits-all. Different configurations exist based on staple material, firing mechanism, and intended clinical application. Understanding these differences helps match the device to the surgical scenario and patient needs.

Traditional Metal Skin Staplers

Traditional metal staplers are disposable handheld devices pre-loaded with stainless steel or titanium staples that pierce the skin surface and bend underneath to hold wound edges together.

Mechanism: The manual trigger drives the staple through epidermis and dermis, forming a bridge across the wound. Each squeeze deploys one staple, with devices typically holding 10-35 staples depending on the model.

Key difference: These represent the most widely used, lowest-cost option but require a separate removal procedure 7-14 days post-surgery. Manual staplers account for approximately 70% of the market share due to low acquisition costs and widespread familiarity.

Best suited for:

  • Trauma and emergency settings where speed is paramount
  • Scalp closures (hair hides scars)
  • Orthopedic incisions on covered body areas
  • High-volume surgical settings prioritizing efficiency over cosmetics
  • Situations where follow-up for removal is reliable

Key strengths:

  • Rapid application (3-4X faster than suturing)
  • Strong wound approximation
  • Minimal training required
  • Widespread availability and team familiarity
  • Low device acquisition cost

Limitations and trade-offs:

  • Create visible "train-track" scarring if left in place >7 days
  • Staple removal is significantly more painful than suture removal (mean pain score 3.7 vs 2.5 on visual analogue scale)
  • Require removal appointments, which patients sometimes miss
  • Contraindicated in cosmetically sensitive areas
  • Higher infection risk in certain procedures like hip arthroplasty

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Removal timeline by anatomical site:

Anatomical SiteRemoval Window
Scalp7-10 days
Trunk and extremities7-14 days depending on tension and healing status

Powered/Automatic Skin Staplers

Powered staplers are battery-operated or spring-loaded devices that automate the stapling process with consistent firing pressure and reduced hand fatigue.

Mechanism: A motorized or spring-assisted mechanism delivers uniform staple formation with each trigger pull. The automation ensures consistent compression force regardless of surgeon hand strength or fatigue level.

Key difference: The primary advantage is consistency. Benchtop testing demonstrates powered staplers provide more uniform compression with malformed staple frequency of 1.14% versus 4.28% for manual systems (p<0.001).

Best suited for:

  • Long incisions requiring many staples (20+ staples)
  • Bariatric surgery closures where tissue thickness varies
  • High-volume procedures where hand fatigue is a concern
  • Situations where multiple team members of varying experience perform closures

Key strengths:

Limitations and trade-offs:

Bioabsorbable Subcuticular Staplers

Bioabsorbable staplers place fasteners below the skin surface (subcuticular layer) rather than piercing the epidermis, eliminating the need for removal.

Mechanism: The device inserts fasteners made of bioabsorbable polymer materials—typically polylactic-co-glycolic acid (PLGA)—beneath the skin where they hold dermal layers together.

The fasteners maintain 80% of their strength for 21 days before being gradually absorbed by the body over 90-120 days. The external skin surface is never pierced during deployment.

Key difference: This represents a fundamentally different approach. Traditional staplers pierce through all skin layers, while bioabsorbable systems use retractable needles to place fasteners entirely within the dermal tissue.

This subcutaneous placement eliminates train-track scarring and removal procedures.

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Best suited for:

  • Cosmetically sensitive areas (face, neck, visible extremities)
  • Pediatric patients where removal causes trauma and anxiety
  • Patients with limited follow-up access (rural populations, socioeconomic barriers)
  • Plastic and reconstructive procedures prioritizing aesthetic outcomes
  • Cesarean sections and other obstetric closures
  • Minimally invasive surgery (MIS) trocar incisions

Key strengths:

Limitations and trade-offs:

  • Higher upfront device cost compared to traditional staplers
  • Learning curve for subcuticular placement technique
  • Limited availability as emerging technology category
  • Less familiar to surgical teams accustomed to traditional methods

One example of this technology is SubQ It! from Opus KSD, which received FDA 510(k) clearance K131563 in 2014 for closing incisions in abdominal, thoracic, gynecologic, orthopedic, plastic, and reconstructive surgery. The system combines the speed advantages of traditional staplers with the cosmetic benefits and patient comfort of absorbable closures.

How to Choose the Right Type of Skin Stapler

The "right" stapler depends on balancing clinical requirements, patient factors, cosmetic expectations, and practical constraints rather than defaulting to the most familiar option.

Six key factors guide stapler selection in clinical practice.

Wound Location and Cosmetic Sensitivity

Visible areas demand different approaches:

  • Face, neck, forearms: Prioritize bioabsorbable staplers or sutures to avoid permanent train-track marks
  • Scalp: Traditional metal staplers work well since hair conceals scars
  • Trunk and covered extremities: Either traditional or bioabsorbable staplers acceptable depending on patient preference
  • Cosmetically sensitive patients: Consider bioabsorbable options regardless of location

Studies in breast reconstruction show removing metal staples between days 5-7 is crucial to avoid permanent train-track marks. Timing mistakes happen frequently in busy surgical practices.

Patient Follow-Up Reliability

Consider removal logistics:

  • Patients unlikely to return (rural/remote, transportation barriers, socioeconomic factors): Bioabsorbable staplers eliminate this risk
  • Paediatric patients: Removal causes significant anxiety and trauma—absorbable options preferred
  • International patients returning home: Cannot rely on removal appointments
  • Reliable local patients with good follow-up: Traditional staplers remain viable

Procedural Volume and Time Pressure

Speed matters in specific contexts:

  • High-volume trauma centres: Traditional metal staplers offer fastest closure at lowest cost
  • Emergency department lacerations: Speed may outweigh cosmetic concerns
  • Elective cosmetic procedures: Time for superior technique is available
  • Operating room efficiency goals: Balance speed with total episode costs including removal

Wound Tension and Healing Characteristics

Mechanical requirements vary:

  • High-tension closures (abdominal wall, areas under mechanical stress): May require holding strength of metal staples
  • Low-tension closures (facial procedures, well-approximated edges): Bioabsorbable options provide adequate strength
  • Compromised healing (diabetes, immunosuppression, poor nutrition): Evaluate infection risk differences between staple types

Research shows metal staples carry over three times greater infection risk in orthopaedic procedures (P=0.01), though evidence is mixed across specialties.

Budget and Reimbursement Considerations

Total cost of ownership matters more than device price:

CMS and private payers bundle wound closure supplies into the global surgical fee. There is no separate reimbursement for routine staple removal during the global period.

Cost components to evaluate:

  • Device acquisition cost (staplers range from $5-50 depending on type)
  • Operating room time savings (faster closure = lower OR costs)
  • Removal visit costs (clinic time, supplies, nursing staff)
  • Patient satisfaction and potential quality metrics
  • Complication costs (infection treatment, wound dehiscence)

Budget impact analyses suggest closure systems avoiding removal visits save $40-55 per patient by reducing clinic time and supply use.

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Surgeon Experience and Training

New technologies require investment:

  • Traditional staplers: Minimal training, universal familiarity
  • Powered staplers: Slight learning curve, similar technique
  • Bioabsorbable subcuticular staplers: Require initial training but technique is learnable quickly

Training studies with bioabsorbable staplers show surgeons achieve near-perfect performance after basic instruction with surrogate materials.

What to Check Before Finalising a Skin Stapler Selection

What to Check Before Finalizing a Skin Stapler Selection

Avoiding common selection mistakes ensures optimal outcomes and cost-effectiveness. Here are critical pitfalls to watch for:

Common selection mistakes to avoid:

  • Choosing advanced options when simpler devices suffice — A scalp laceration in a patient with reliable follow-up doesn't require bioabsorbable staplers. Traditional metal staplers achieve equivalent outcomes at lower cost.

  • Ignoring patient-reported outcomes — Pain during removal, anxiety about staple extraction, and dissatisfaction with cosmetic scarring significantly affect quality of life. Studies document significantly higher pain scores for staple removal (mean VAS 3.7) compared to sutures (mean VAS 2.5).

  • Overlooking total cost of ownership — Focusing only on device acquisition price misses the bigger picture. Include removal procedure costs, supplies, nursing time, and potential complications. A $10 metal stapler requiring a $50 removal visit costs more than a $30 bioabsorbable system like SubQ It! that requires no removal.

  • Ignoring infection risk differences by procedure type — In hip arthroplasty, staples carry significantly higher SSI risk (RR 2.51, 95% CI 1.15-5.50) compared to sutures. Procedure-specific evidence should guide selection.

  • Defaulting to familiar options without evaluating alternatives — "We've always used metal staplers" isn't a clinical justification. Evaluate whether newer technologies offer meaningful benefits for your patient population.

Conclusion

Selecting the right closure device directly impacts patient outcomes, satisfaction, and resource efficiency. Three distinct stapler types—traditional metal, powered, and bioabsorbable subcuticular—each address different clinical and patient needs.

The evidence-based selection framework comes down to three key factors:

  • Patient journey: Does your closure method require a removal visit, or does it eliminate follow-up?
  • Cosmetic outcome: Will the closure method minimize scarring for optimal healing?
  • Clinical efficiency: Does the device match your volume needs and workflow constraints?

Moving beyond device familiarity to match these factors with your surgical scenarios improves outcomes across the board.

In practice, this means different tools for different contexts. Surgical teams seeking to eliminate removal visits while improving cosmetic outcomes will find bioabsorbable subcuticular systems like SubQ It! align with those goals. High-volume trauma settings prioritizing speed and cost-efficiency may find traditional metal staplers more appropriate.

Your specific clinical context and patient population determine the right choice.

Frequently Asked Questions

What kind of stapler is used for stitches?

Skin staplers are specialised medical devices using sterile titanium or stainless steel staples, or bioabsorbable fasteners, specifically designed for wound closure. These are not office staplers—they're precision surgical instruments engineered for consistent tissue approximation and safe healing.

How does a suture stapler work?

The device drives a staple through skin edges, bending the legs underneath to hold wound margins together. In bioabsorbable versions, retractable needles place fasteners entirely within the subcutaneous tissue without piercing the external skin surface, then the needles retract leaving the fastener embedded in the dermal layer.

How long do staple sutures stay in?

Traditional metal staples remain 7-14 days depending on location (scalp 7-10 days, trunk/extremities 7-14 days). Bioabsorbable fasteners absorb over 90-120 days with no removal needed, maintaining 80% strength for the critical first 21 days.

What are the advantages of surgical staplers over sutures?

Staplers close wounds 3-7X faster than sutures, reduce operative time and anesthesia exposure, and provide consistent wound approximation with minimal training. This speed advantage is particularly valuable in trauma, emergency departments, and high-volume practices where efficiency impacts patient throughput.

Are surgical staples safe for all skin types?

Modern titanium and bioabsorbable staples are biocompatible and safe across all skin types. However, train-track scarring from metal staples may be more visible in darker skin tones, making bioabsorbable subcuticular options like SubQ It! preferable for cosmetically sensitive areas.

What is the difference between skin staplers and internal surgical staplers?

Skin staplers close external wounds on the body surface after surgery or trauma, while internal staplers connect or resect internal organs during surgery. Internal staplers use different staple sizes and mechanisms designed for organ tissue rather than skin.