While surgical stapling is often viewed as a relatively new surgical tool, it was first invented in 1908. Made of stainless steel or titanium (or sometimes nickel, chromium, plastic, or iron), 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.
Staples or Stitches? 3 Factors to Consider
1. Risk of Infection
Wound complications are one of the main sources of illness following orthopedic surgery, extending a patient's stay in the hospital or even lead to re-admission. 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 683 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. While this may seem pretty conclusive, the authors go on to state that the quality of evidence was generally poor and that more trials are needed to make any sort of definitive statement.
2. Application and Removal Time
Today, demand for orthopedic surgeons’ time remains a big challenge. 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 in mass casualty situations. In a physicians 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.
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.
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. It’s also a time-saver; the bandage can be applied by a wide range of healthcare professionals without the involvement of the orthopedic surgeon or a return visit.