Sutures or staples? This wasn’t really a question until just about fifty years ago. Sutures have been used since the 16th century BCE, while the idea of stapling didn’t come to fruition until early in the 20th century CE. The "father of surgical stapling," Hungarian physician Hümér Hültl, invented the first surgical stapling device in 1908, with a prototype stapler weighing in at eight pounds and requiring two hours to assemble and load. By the 1970s, however, the technology was refined into the more-widely known device we know today.
TODAY’S SURGICAL STAPLES
Made of stainless steel or titanium (or sometimes nickel, chromium, plastic, or iron), surgical staples are usually used to close deep lacerations which aren’t appropriate for ordinary stitches, or for areas of the body under high tension. Staples are curved, straight, or circular, and unlike “office staples,” which require an anvil that the staples are pressed against to form a hook, surgical staples have bent prongs with no anvil required. Staples may be used on the abdomen, legs, arms, scalp, or back; however, they should not be used on the neck, feet, or face.
While staples can provide a quick and necessary “quick fix” in emergency situations, the limitations of where can be used on the body can greatly affect first responders, especially in mass casualty situations when they need to quickly determine the best method of wound closure to stop the bleeding. Each year, about 60,000 Americans die from blood loss, with as many as 1.5 million of these hemorrhaging deaths being caused by physical trauma. Studies also show that more than 50% of people with traumatic injuries involving hemorrhaging die within minutes of accident or injury, so proper and quick wound closure is crucial.
3 FACTORS TO CONSIDER WHEN USING STAPLES
1. APPLICATION AND REMOVAL TIME
Today, demand for surgeons’ time remains a big challenge, and wasted time is leading to physician burnout. Stapling can usually be performed quicker than suturing, saving about 2-3 minutes of time, which is why stapling is the preferred method of choice for trauma care involving mass casualties, whether it’s a natural disaster, major vehicular accident, or even a shooting. In a physician’s office. however, stapling requires the use of two healthcare professionals (one to align the skin with forceps, and another to apply the staples) versus only one for suturing. And while both stapling and most suturing require return visits for removal, staple removal in particular requires usage of a special tool versus a simple set of scissors for sutures. There are times when staples can become embedded in the skin, making removal difficult; on rare occasions, staples can become completely lodged within the skin, requiring a new incision to remove the buried staple.
2. RISK OF INFECTION
Wound complications are one of the main sources of illness following surgery, extending a patient's stay in the hospital or even leading to readmission. To find out which were less likely to lead to infection—stitches or staples—researchers analyzed the results of six trials, comparing both methods following surgeries in over 680 adults. They compared the use of staples to sutures following orthopedic procedures in adults. Their conclusion? The risk of developing a superficial wound infection was over three times greater after staple closure than suture closure, and for hip surgery in particular, staples were four times more likely to lead to infection.
Just as with sutures, staples can cause scarring. Because staples do not allow for precise wound alignment, healthcare professionals should not use staples on the face or neck (and discomfort makes them a poor choice for usage in the hands or feet). In patients who easily scar, staples could make their scar more pronounced, especially if the staples are left in for any stretch of time (>5 to 15 days, depending upon the location). Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 receiving sutures. There was some variance in weight and aging, but women with staples reported worse median cosmetic scores, darker scar color, and more skin marks compared to women with suture closure. Surprisingly, there was no group difference regarding satisfaction with their scar.
AN ALTERNATIVE TO SURGICAL STAPLES
Today, new technologies have eliminated the this-or-that nature of wound closure methods. Introducing BandGrip, an alternative to staples and stitches that’s designed for speed and ease of use. BandGrip is a 3.5”x1.5” bandage offering a non-invasive method of wound closure (it can also be tiled for large incisions). It uses non-invasive micro-anchors that grip the skin gently and securely to pull wound edges together, and reduce wound closure time by more than 30%. In addition, scarring is less pronounced, leaving patients more satisfied with the results of their procedure (and their surgeon). The photos below highlight the scar-reduction abilities of BandGrip.
As you can see, surgical staples don’t allow for precise wound alignment, leading to the arched stapling shown in the first photo. In most patients, stapling also makes their scar more pronounced and darker in color, especially if the staples are left in for a while. With BandGrip, wound closure can be better aligned, resulting in a more seamless appearance, with much less pronounced scarring.
BandGrip is also a time-saver; the bandage can be applied by a wide range of healthcare professionals without the involvement of the surgeon—which also makes it a life saver.
You can see it in action by checking out the video below.