Wound Closure: Surigical Staples

Composition and Material:

Staples are formed from high-quality stainless steel and are available in regular and wide sizes.

Staples are composed of:

(1) a cross-member that lays on the surface of the skin perpendicular to the wound,

(2) legs that are vertically placed in the skin

(3) tips that secure the staple parallel to the cross-member.

In dermatologic surgery, the staplers used are disposable and loaded with 5-35 staples, depending on the manufacturer.

They are lightweight and have handles that are easy to grip and control.

The width and height of the staples vary with the manufacturer. Most regular staples are 4-6 mm wide and 3.5-4 mm high.

Wide staples for use in thicker skin are 6.5-7.5 mm wide and 4-5 mm high.

The Stapler:

Staplers that are used widely in dermatologic surgery include Appose (Autosuture, United States Surgical), Proximate (Ethicon), and Precise (3M). A unique stapler is the Multifire Premium stapler (Autosuture), which is disposable but can be reloaded for continued use on the same patient.

Indications for use:

 Staples are relatively easy to place and may shorten the closure time by 70-80%.

The primary utility of staples is in the closure of wounds under high tension on the trunk, extremities, and scalp.

They are also used to secure split-thickness skin grafts.

Advantages of staples include:

  •  rapid speed of closure
  • a decreased risk of infection
  • improved wound eversion
  • minimal tissue reactivity.

Contraindications:

They are not used in delicate tissues or wounds in finely contoured areas, over bony prominences, or in highly mobile areas.

Several studies have been conducted to compare the use of staples and nylon sutures on the trunk, head, and neck; these revealed comparable cosmetic results.

 Disadvantages include

  • the need for a second operator to evert and reapproximate skin edges during staple placement
  • greater risk of crosshatch marking
  • less precise wound approximation.
  • The cost is usually more than that of suture material.

Placement:

For staple placement, the stapler is gently held on the surface of the skin, perpendicular to the wound.

The handle is squeezed, plunging the staple into the skin to form an incomplete rectangle.

The depth of penetration is based on the pressure exerted on the stapler against the skin.

To disengage the staple, the handle is released.

If the stapler has an ejector-spring release, it is lifted vertically off the skin.

If not, the stapler must be moved anteriorly or posteriorly.

The correct placement of staples is critical to avoid complications such as tissue strangulation and crosshatch marking.

Staples should be inserted at 45° or 60° angles.

As a wound swells, a staple placed at an acute angle rotates into a vertical position, leaving a space between the cross-member and the skin surface to accommodate swelling.

If placed at a 90° angle, the staple cannot move and is likely to strangulate the tissue during swelling.

 

Staple Removal:

Staples are removed painlessly by using a specialized set of extractors.

Terhune, Margaret . 2009. Material for Wound Closure. Retrieved November 17, 2009 from http://emedicine.medscape.com/article/1127693-overview

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