Introduction
Every year, surgeons perform over 300 million surgical procedures worldwide, and each one ends with a critical decision: how to close the incision. This choice directly impacts wound healing, infection rates, scarring, patient comfort, and healthcare costs.
The traditional debate between sutures and staples isn't just about technique—it's about patient outcomes and surgical efficiency.
Research shows that sutures result in approximately 50% lower wound complication rates compared to staples in many surgical contexts. Yet staples remain popular in emergency and high-volume settings because they close wounds 3-4 times faster. Neither method is universally superior, making the choice highly context-dependent.
This guide explores when to use each method—and examines emerging alternatives—to help improve surgical outcomes while optimizing operating room efficiency.
TLDR
- Superior cosmetic outcomes and 50% lower complication rates make sutures the standard for most closures
- Staples close wounds 3-4X faster, saving 5-7 minutes in emergency and high-volume cases
- Wound location, tension, cosmetic priority, and efficiency drive closure method selection
- Bioabsorbable subcuticular systems deliver stapler speed with suture-quality cosmetic results
- Consider infection risk, cosmetic goals, patient comfort, and removal requirements
Sutures vs Staples: Quick Comparison Table
Choosing between sutures and staples depends on multiple factors including procedure type, cosmetic priorities, and patient comfort considerations. The table below compares traditional closure methods across key decision criteria.
| Aspect | Sutures | Traditional Metal Staples |
|---|---|---|
| Closure Speed | 9-15 minutes for typical incision | 3-5 minutes (3-4× faster) |
| Wound Complications | ~4.9% infection rate; lower dehiscence risk | ~6.8% infection rate; 2-4× higher risk in orthopedic procedures |
| Cosmetic Outcomes | Superior edge approximation; minimal scarring | "Train track" scarring pattern; less precise alignment |
| Patient Comfort | Minimal discomfort during and after placement | Quick placement but painful removal (2-3 points higher on pain scales) |
| Cost Considerations | Higher material cost; absorbable types need no removal visit | Lower device cost but removal visit adds $500+ to total cost |
| Ideal Use Cases | Facial/cosmetic areas, low-tension wounds, pediatrics, cesarean sections | Emergency trauma, scalp lacerations, lengthy procedures, low-cosmetic-priority areas |
Beyond Traditional Options: Bioabsorbable subcuticular closure systems like SubQ It! combine the speed advantages of staples (7× faster than manual sutures) with the superior cosmetic outcomes of sutures, while eliminating the need for removal visits entirely.
What are Sutures?
Surgical sutures are thread-like materials used to bring together wound edges through manual stitching techniques. They remain the gold standard for precise wound closure, offering versatility across diverse tissue types and surgical specialties.
Categories and Materials
Sutures fall into two main categories based on degradation profiles:
Absorbable sutures lose 50% of their tensile strength within 60 days and degrade naturally through hydrolysis (synthetic) or enzymatic digestion (natural). These eliminate removal procedures entirely.
Non-absorbable sutures retain at least 50% of their tensile strength for more than 60 days. They typically require removal when used for skin closure to prevent foreign body reactions and characteristic "railroad track" scarring.
Common suture materials include:
- Polyglactin 910 (Vicryl): Braided absorbable, often coated to reduce infection
- Polydioxanone (PDS): Monofilament absorbable for high-tension areas
- Nylon & Polypropylene: Monofilament non-absorbable, ideal for external closure
- Silk: Natural fiber with excellent handling but higher tissue reactivity
Clinical Evidence and Benefits
Understanding material types helps explain why sutures perform well clinically across multiple surgical specialties.
Systematic reviews of 42 randomized controlled trials involving 11,067 patients found sutures resulted in fewer overall wound infections (4.90%) compared to staples (6.75%). In cesarean sections specifically, sutures significantly reduced wound separation risk (RR 0.43).
Key benefits include:
- Superior cosmetic outcomes with precise edge alignment
- Lower infection rates in orthopedic and cesarean procedures
- Versatility across wound types and tension levels
- Precise tension control for optimal healing
Use Cases for Sutures
Given these clinical advantages, sutures remain the preferred choice when cosmetic outcome is paramount or when wounds require precise approximation.
Primary indications include:
- Facial and cosmetically sensitive areas (plastic surgery, facial trauma)
- Low-tension wounds where tissue approximates easily
- Pediatric patients (absorbable types avoid removal trauma)
- Cesarean sections (guidelines strongly support sutures, reducing complications ~50%)
Specialty-Specific Evidence
In facial procedures, systematic reviews found absorbable sutures yielded comparable aesthetic outcomes to non-absorbable ones while avoiding removal—making them suitable even in cosmetically sensitive areas.
For orthopedic hip arthroplasty, sutures are recommended due to staples carrying 4-fold higher infection risk (RR 4.79), which can lead to devastating deep prosthetic infections.
What are Staples?
Surgical staples are metal fasteners—typically stainless steel or titanium—that mechanically approximate wound edges through a stapler device. They're designed for speed and ease of use, particularly in long linear incisions.
Mechanism and Variations
The stapler device drives staples through skin edges, forming them into a closed rectangular loop that everts the skin edges to promote healing.
Variations include standard staples, wide staples for different tissue thicknesses, and disposable versus reusable staplers.
Speed Advantage
Beyond their mechanical simplicity, staples offer a significant practical advantage: speed.
The primary benefit of staples is dramatically faster closure time. Meta-analysis data shows staples save an average of 5.84 minutes per wound compared to sutures. In head and neck cancer surgery, staple closure was ten times faster—3.3 minutes versus 34.2 minutes for sutures.
Core benefits include:
- Significantly faster closure (3-4X faster than sutures)
- Reduced surgical time in lengthy procedures
- Minimal tissue handling required
- Ease of use with short learning curve
Use Cases for Staples
Staples excel when operative speed is critical or when dealing with high-volume trauma situations.
Primary indications include:
- Emergency surgery and trauma — rapid closure reduces door-to-disposition time in emergency departments
- Scalp lacerations — studies confirm staples are faster and less expensive with no significant difference in complication rates
- Lengthy procedures — time savings accumulate when multiple closures are needed
- Orthopedic surgery — widely used in knee arthroplasty for speed, though evidence shows significantly higher risk of superficial wound infection (RR 3.83)
In emergency settings, staples closed lacerations 2.7 times faster than sutures, making them valuable when rapid treatment is essential.
Sutures vs Staples: What is Better?
Neither method is universally superior—the optimal choice depends on balancing infection risk, cosmetic priorities, pain considerations, and efficiency requirements.
Key Decision-Making Factors
Wound location and cosmetic importance:
- Face/neck/visible areas: Choose sutures (subcuticular technique)
- Trunk/extremities with low cosmetic priority: Staples acceptable
- Areas prone to tension: Both methods have separation risk; consider reinforcement
Wound tension and depth:
- High-tension wounds may separate with either method
- Deep wounds benefit from layered closure with absorbable sutures for fascia
- Superficial wounds in low-tension areas: Either method appropriate
Patient factors:
- Age: Pediatric patients benefit from absorbable sutures (no removal)
- Skin quality: Thin or fragile skin may tear with staples
- Healing capacity: Compromised healing favors sutures (lower infection risk)
- Patient preference: Some patients strongly prefer avoiding staple removal
Surgical efficiency requirements:
- Emergency/trauma: Staples save critical minutes
- Elective procedures with time: Sutures provide better outcomes
- High-volume settings: Consider bioabsorbable alternatives that combine speed with quality
Post-operative care logistics:
- Patient ability to return for removal: If questionable, use absorbable methods
- Healthcare access: Rural/underserved populations benefit from no-removal options
Beyond the technical factors above, patient comfort during removal plays an important role in closure selection.
Pain During Removal
Research consistently shows that staple removal is significantly more painful than suture removal, with pain scores typically 2-3 points higher on 10-point scales.
This difference affects patient experience and can create anxiety about follow-up visits.
Evidence-Based Recommendations
Choose sutures when:
- Cosmesis is paramount and time allows
- Infection risk is elevated (orthopedic implants, compromised patients)
- Performing cesarean sections or facial procedures
- Patient comfort and satisfaction are priorities
Choose staples when:
- Surgical efficiency is critical (emergency, trauma)
- Cosmetic outcome is secondary
- Closing scalp lacerations or low-visibility areas
- Multiple closures needed in lengthy procedures
Emerging Alternatives
Bioabsorbable subcuticular closure systems like SubQ It! represent a third category that addresses traditional trade-offs. These devices place absorbable fasteners beneath the skin surface, combining mechanical application speed (7X faster than manual sutures) with suture-quality cosmetic outcomes while eliminating removal needs entirely.
Real World Examples and Case Studies
Clinical studies at Northern Vermont Regional Hospital tracked seven surgeons and 50 patients across 16 different surgical procedures.
The results demonstrate how bioabsorbable subcuticular closure addresses limitations of both traditional methods.
The Clinical Challenge
Surgical teams faced a persistent dilemma between two imperfect options:
Manual Suturing: Superior cosmetic outcomes but consumed valuable OR time (42 seconds per stitch)
Metal Staples: Fast deployment (7 seconds per staple) but created "train track" scarring and required painful removal procedures costing over $500 per patient visit
Bioabsorbable Subcuticular Technology
The team adopted SubQ It!, a bioabsorbable subcuticular closure system that places absorbable fasteners entirely beneath the skin surface—maintaining surgical efficiency while improving patient satisfaction and cosmetic outcomes.
Outcome Metrics
The results demonstrated significant improvements across multiple measures:
Closure Time Reduction: Each bioabsorbable fastener deployed in just 7 seconds—matching staple speed but delivering subcuticular closure quality. This represented 7X faster closure compared to manual sutures (which require 42 seconds per stitch), or approximately 85% reduction in closure time.
Wound Complication Rates: The clinical study documented low complication rates with only 2% infection rate and 17% incidence of bleeding—significantly better than the ~6.8% infection rate typically associated with metal staples.
Elimination of Removal Visit: The bioabsorbable PLGA fasteners maintain 80% of their strength for 21 days before being naturally absorbed by the body, completely eliminating the need for removal appointments and associated $500+ costs.
Patient comfort and cosmetic outcomes showed marked improvements:
Patient Satisfaction: Pain assessments using 0-10 scales showed favorable outcomes, with patients reporting improved comfort over time. The subcutaneous placement eliminated the characteristic discomfort of metal staple removal, which typically scores 2-3 points higher on pain scales.
Cosmetic Outcomes: Photographic documentation using the Hollander wound evaluation scale showed excellent healing progression. Laparoscopic cholecystectomy patients demonstrated minimal visible scarring at 22 and 45 days post-surgery, while cesarean section closures showed superior aesthetic results at 6 weeks compared to traditional metal staples.
Practical Takeaway
Bioabsorbable subcuticular systems deliver the speed of staplers with the cosmetic benefits of sutures while eliminating removal procedures entirely. For surgical teams seeking to optimize both efficiency and patient outcomes, these systems represent a viable alternative to the traditional sutures-versus-staples debate.
Discover how bioabsorbable subcuticular closure systems like SubQ It! combine the speed of staples with the cosmetic outcomes of sutures—contact us to learn more about optimizing your surgical closures.
Conclusion
The sutures versus staples decision should be guided by wound characteristics, surgical context, and desired patient outcomes. Both methods have proven effective for decades, with sutures offering superior cosmetic results and staples providing speed advantages in specific scenarios.
However, modern bioabsorbable closure systems now combine the benefits of both approaches. These devices deliver the speed of stapling with the cosmetic outcomes of subcuticular sutures, while eliminating staple removal procedures entirely.
When evaluating closure options for your practice, consider not just the immediate procedural efficiency but also the total cost of care, patient comfort, and long-term aesthetic results. The right closure method balances surgical demands with patient-centered outcomes.
