Skin Stapling

CHAPTER 34 Skin Stapling



David James


In certain body areas, when performed with care, skin stapling provides a rapid and simple alternative to other methods of skin closure and wound repair. Clinical experience with stapling now spans decades, and improved equipment, such as absorbable staples, is being introduced constantly. A variety of staplers with specific features for the purpose to which they are being applied are available. For example, staplers designed for small lacerations may hold only 5 fine staples, whereas staplers for general-purpose closure may hold up to 35 heavier-gauge staples.



Advantages


The final result of a stapled wound depends directly on its location, the condition of the wound being stapled, and operator experience. The best cosmetic results are seen in clean, uninfected linear wounds of the scalp, torso, and proximal extremities that have some degree of a subcutaneous fat “bed” and that are not under undue tension. Poorer results occur when the wound is macerated, ragged, infected, under tension, or placed directly over a bony prominence with thinner skin.


Numerous studies have supported stapling as an acceptable alternative to suture closure, and in some studies a lower rate of infection after closure has been found with stapling. Staples are generally well accepted by patients, and, in most cases, it is a much faster procedure than suturing. Well-placed staples evert the wound edges optimally and place less tension on wound edges than sutures. Surgical stainless steel staples are less “reactive” than sutures and potentially result in less postclosure inflammation and infection. Staple ends do not completely meet in the deeper tissues, thus resulting in less tissue constriction; this may also promote a lower infection rate.



Disadvantages


Stapling has the potential to provide a result inferior to suturing. Staples certainly do leave larger puncture scars proportional to the time they remain in the wound, and the cost–benefit ratio of using a stapling device in smaller wounds is not advantageous. Recycling of the used devices are also problematic because most are made of plastic and are for single-use only.



Indications



• To secure skin grafts or repair wounds whose edges are easily approximated and not under undue tension

• Long, linear wounds of the scalp, proximal extremities, or the torso where cosmesis is not a concern


Contraindications



• Facial or neck tissue, or in areas where there is an inadequate subcutaneous base

• Over small mobile joints of the hand and foot, soles and palms, or any other location where the staples may interfere with function of a body part

• In wounds that are macerated or infected, or over areas of large tissue loss, unless the subcutaneous tissues may be easily approximated after undermining and use of buried deeper sutures to help approximate the skin edges


Equipment



• Skin hooks or two pairs of fine Adson forceps

• Skin stapler with appropriate-gauge staples (heavier gauge for longer wounds over thicker tissue, lighter gauge for smaller wounds)

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Skin Stapling

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