How do they staple skin?

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What are surgical staples?

Surgical staples are used to close incisions after surgery. Staples may be a better option in some cases than stitches or sutures.

Unlike stitches, surgical staples don’t dissolve as your incision or wound heals. For this reason, they require some special care and must be removed by your doctor once the incision has healed.

How long do they need to stay in your body?

Surgical staples need to stay in for a few days or up to 21 days (in some cases) before they can be removed.

How long your staples must stay in place depends largely on where they’re placed and other factors such as:

• the size and direction of the incision
• the type of surgical procedure you had
• the complexity or severity of your incision or wound
• how quickly the area heals

For example, after a C-section, staples used to close a low transverse (horizontal across the body) incision may be removed after three to four days. But staples used in a vertical incision may not be removable for 7 to 10 days or more.

Several indicators that your surgical staples may be ready to be removed include:

• The area has healed well enough that staples aren’t needed anymore and the wound won’t reopen.
• There’s no pus, fluid, or blood drainage from the area.
• There aren’t any symptoms of infection.

Can you remove surgical staples at home?

Never try to remove surgical staples yourself at home. Always have a licensed medical professional remove staples.

Your doctor will follow special procedures and use specific tools in order to safely remove surgical staples without causing complications.

How are they removed?

The exact staple removal procedures your doctor uses will depend on:

• where the staples are located on your body
• what type of surgery you had
• whether they’re used inside or outside your body

It’s usually not painful when your doctor removes your surgical staples. You may feel a tugging or pinching sensation as each staple is removed.

When removing your surgical staples, your doctor will follow these general steps:

1. Remove any wound dressing or other materials covering the area.
2. Look for any abnormal symptoms or issues with the wound’s appearance.
3. Clean and sterilize the entire area with medical antiseptics.
4. Slide the lower part of a staple extractor tool underneath the outermost staple on either side of the stapled area.
5. Wiggle the staple gently side to side until it comes out of the skin.
6. Put the staple on a clean sheet of gauze immediately.
7. Repeat steps 4 to 6 on every second staple along the area until the end of the incision is reached. You may not have all your staples removed at a single appointment if the area is not fully healed.
8. Remove all remaining staples.
9. Put a sterile strip on each area from which a staple was removed.

Some staples may stay inside your body permanently. This is often done to keep internal organ tissues connected and resistant to further damage.

When are surgical staples used?

Surgical staples are used to close surgical incisions or wounds that are too big or complex to close with traditional stitches. Using staples can decrease the time needed to complete surgery and can be less painful.

Staples may be simpler, stronger, and speedier to use to close large, open wounds than traditional stitches, and may be used after major surgery.

For example, staples are often used after C-sections because they help the incision heal faster while also reducing scar appearance.

How do I care for surgical staples?

After getting staples, the following steps will help keep them clean as you heal:

• Follow all postsurgical instructions from your doctor.
• Don’t remove any dressings or bandages until your doctor says it’s safe to do so.
• Rinse the area gently with clean water twice a day.
• Use Vaseline or petroleum jelly and a sterile bandage that doesn’t stick to cover the area.
• Replace bandages at least once a day or every time it gets soiled or wet.

What are surgical staples made of?

Some common surgical staple materials include:

• Titanium. Known to easily adhere to both bodily tissues and bone, titanium is less likely to cause inflammation or infection.
• Plastic. This material is used if you’re allergic to metals found in other surgical staples.
• stainless steel. Plastic is commonly used for staples and may help reduce scar appearance.
• Polylactide-polyglycolide copolymer. This material is easily reabsorbed into the body. It’s popular in plastic surgery because it’s less likely to leave a noticeable scar following healing.

How are surgical staples placed?

Surgical staples are placed with a special stapler.

They don’t look quite the one on your desk. Surgical staplers look more like commercial-grade construction staplers with a handle and lever that your doctor pushes down to place the staple.

Surgeons use these specially designed staplers to safely, quickly, and precisely place surgical staples on a wound. The process is much faster than stitching or suturing because the staples are placed instantly.

What are the risks of surgical staples?

Surgical staples do carry some risks, including:

• infection from not taking care of the wound (or from bacteria getting into the area)
• improper placement of the staples causing the wound to heal poorly or not close all the way
• wound reopening after staple removal (if staples are removed too early)
• allergic reaction to staple materials

For more information, please visit Gastroscopy Biopsy Forceps.

When should I call a doctor?

Seek emergency medical attention if you notice any of the following symptoms around the area that’s been stapled:

• severe or new pain
• bleeding from your incision
• redness or swelling of your incision and surrounding area
• increase in the size or depth of the stapled area
• dark or dry appearance around the stapled area
• thick, bad-smelling pus or discharge colored yellow, green, or brown
• low-grade fever (100°F or higher) that lasts for four hours or more

The takeaway

Staples have a number of advantages over stitches for especially large or complex surgeries, injuries, or incisions. In some cases, they may even lower your chances of complications like infection.

Talk to your doctor before getting staples. Be sure to let your doctor know about any allergies you may have and if you’ve had any complications from surgical staples in the past.

Clinical Exercise: Scalp Laceration (stapling)

Scenario:

Following a bus collision several dozen injured patients are transported to shock trauma and the emergency department. Many of the injuries consist of lacerations from sharp edges of metal and glass during the collision including several with deep scalp lacerations bleeding profusely. 

Diagnosis/Considerations:

You recognize that for most minor wounds suturing provides for the two primary goals, hemostasis and achievement of a functional scar that is cosmetically acceptable.

Staples are an acceptable alternative for linear lacerations through the dermis that have straight, sharp edges and are particularly well suited for scalp lacerations. The closure of scalp wounds with staples is faster than sutures with similar outcomes when compared to sutures (indistinguishable infection, healing time, and cosmetic outcomes compared to sutures). However, since meticulous skin positioning is not readily achievable with staples, injuries involving the face should be closed with sutures. Additionally, due to patient discomfort injuries to hands and feet are also typically not closed with staples.

Because staples may be placed more rapidly than sutures and eliminate the risk of needle stick injury which is elevated in the busy environment of a multiple casualty event, you decide that the patient's scalp wound is best addressed using a skin stapler.

Mechanism:

The goal is to bring the edges of the cut tissues close together to promote healing and provide sufficient security across the opening to achieve hemostasis.

Modern surgical staplers consist of disposable plastic dispensers that can deliver single staples either with a low profile head (usually for skin) or a long endoscopic head that can be articulated (to allow reaching deep structures through a small opening). For a scalp laceration a low profile head provides suitable access.

The use of a skin stapler involves light compression of the skin on each side of the laceration with forceps in order to bring the edges into continuity. Pressure slightly elevates the skin edges of the laceration for the staple to penetrate.

Treatment (perform these steps on the donor in a mock-procedure):

PREPARATION: Send a member of your team to the instrument supply tables to fetch one 35-staple skin-type disposable dispenser and one staple remover, which looks like a small white handle scissor-like instrument (please take only the supply numbers indicated to ensure sufficient supplies are available for all tables).

In a living patient, the skin on each side of the laceration would be anesthetized using topical (e.g. lidocaine-epinephrine-tetracaine [LET] gel) or an infiltrate analgesic (e.g. isotonic buffered lidocaine). In our donor we will skip this step.

1) Open the sterile stapler packet, observing the staple delivery and trigger ends of the device.

CAUTION: exercise care when handling staplers to prevent stapling parts of your hand or body. 

Note, it is difficult for one person to staple an incision. Typically, one person will use forceps to control the edges of the laceration to bring them into contact (i.e. reapproximate the edges) while the second person utilizes the stapler.

In a living patient, the skin is controlled using mouse-tooth forceps (i.e. the 'toothed' end forceps style), but with the higher density of tissue in an embalmed donor you may need to use a hemostat (hemostats may damage living tissue).

2) The first person should use forceps, or a hemostat if needed, to position the edges of your prior scalp incision into continuity (i.e. pressing the edges together) applying light pressure so that the skin bulges slightly on each side of the incision.

3) The second person should then position the stapler across the incision site close to the forceps tips, such that the cut edges of the tissue are positioned against the 'gap' in the dispenser from which the staple will be delivered.

4) Squeeze smoothly and firmly on the dispenser trigger and then release.

A staple should have been expelled with one arm of the staple penetrating the tissue on each side of the incision and holding the edges together.

5) Repeat the process approximately 3-5mm along the incision.

Each person should use only 3-4 staples evenly spaced. Each stapler holds only 35 staples and everyone in the team should have the opportunity to use the instrument and be the skin control person. If the stapler runs out, there are several additional at the supply table

Scenario (addendum):

As you place the staples you realize that one of them has been incorrectly positioned and is gripping only one side of the incision. Leaving the incorrectly placed staple in place would interfere with another staple in that location and could cause a weak point that may continue to bleed. Thus, you need to remove the incorrectly placed staple and re-staple securely in that location.  

Treatment (continued):

7) Identify the two sides of the staple remover teeth.

One side will be a flat ring-like structure, with the other side a vertical arm that will pass between/inside the ring. The device operates by bending the center bar of the staple which pulls the ends smoothly out of the skin.

8) Insert the flat ring-like side of the instrument deep to the staple.

9) Close the scissor arms of the instrument which will reform the staple such that it can be lifted out.

Note, the reforming bends the staple into an 'M' so the penetrating arms of the staple are now straightened and slide easily out.

NOTE: when finished suturing ensure that any removed staples are collected into one of your trays and transported to the sharps containers for safe disposal.

Return the staple remover and stapler (if any remain inside it) to the supply table.

Outcome:

The staples are neatly performed and the bleeding is controlled in this patient. You apply light antibiotic ointments to the laceration area and left open to the air (scalp stapling is typically left open, while staples to torso/limbs are covered with sterile dressing). After 7-10 days for skin healing, the patient returns to their regular physician to have the staples removed.

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