Surgery Book


Surgical Staple

Aka: Surgical Staple, Skin Staple, Wound Closure with Staples, Laceration Repair with Staples, Skin Stapler, Surgical Stapler, Closure by Staple
  1. See Also
    1. Wound
    2. Wound Repair
  2. Indications: Skin Staple
    1. Skin closure in regions where tendons and nerves are deeper (Scalp Lacerations)
    2. Rapid closure in actively bleeding wounds (e.g. Scalp Lacerations in multi-Trauma patients)
    3. Partial staple closure as adjunct to suturing other layers
      1. Sutures may be used to close deep layer and reapproximate superficial layer (stay Sutures)
      2. Staples may be used for final closure once deep layers and skin is well approximated
  3. Contraindications: Skin Staple
    1. Planned imaging (see imaging interference under complications as below)
    2. Deep wounds (may Suture deep layers, and use staples for skin closure)
    3. Non-linear wounds
    4. Mis-matched irregular wound edges
    5. Face or neck wounds
    6. Hand or Foot Wounds
    7. Extensor surface wounds
    8. Flexor surface wounds
  4. Background: Advantages
    1. Staple placement can be significantly faster than Suture placement
    2. Eliminates Needlestick Injury risk (except when staples need to be removed and replaced)
    3. Cosmetic results are typically similiar to Sutures
  5. Complications: Skin Staple
    1. Infection
      1. Higher risk of infection when used for post-operative orthopedic and cesarean skin closures
      2. Figueroa (2013) Obstet Gynecol 121(1):33-8 [PubMed]
      3. Smith (2010) J Bone Joint Surg Am 92(16):2732 [PubMed]
    2. Imaging Interference
      1. Creates "shadows" on CT imaging
      2. MRI appears safe after Skin Staples
        1. Gayton (2011) J Trauma 70(5):1279-81 +PMID:20664378 [PubMed]
    3. Misplaced Staples
      1. Staple placement can be more difficult to direct (esp. larger staplers)
    4. Dog Ear
      1. Occurs when one wound edge is longer than the other
      2. Laceration may be extended into the redundant skin edge, with the extra skin resected, then closed
  6. Technique: Skin Staple
    1. Prepare wound site
      1. See Wound Repair
      2. See Wound Irrigation
    2. Precautions
      1. Evert skin edges while stapling
      2. Stapler midpoint should sit over the Laceration line (between the wound edges)
      3. Avoid excessive would pressure while stapling
    3. Procedure
      1. Assistant approximates and everts each skin edge with toothed forceps (one in each hand)
        1. Non-assistant workflow is demonstrated by Dr. Baladi in YouTube Video below
      2. Align midline of stapler directly over the Laceration line
      3. Stapler should be applied gently against skin (without excessive pressure)
      4. Fire the stapler
        1. Do not release the trigger until the forceps are repositioned
        2. Apply slight lift on the stapler to ease skin approximation at the next position
        3. Release the staple trigger once the forceps are repositioned
      5. Assistant moves their forceps to the next position, staple and repeat as needed
      6. Apply wound bandage (e.g. Bacitracin, wound covering)
    4. Disposition
      1. Precautions to return for signs infection
      2. Give clear date by which staples should be removed
        1. See Suture Removal Timing
        2. Delayed staple removal results in worse cosmetic results
      3. Use staple remover (instead of hemostat) for best results
  7. Resources
    1. Skin Stapling Without an Assistant (Dr. Baladi)
    2. Staples (Brian Lin, MD)
  8. References
    1. Warrington (2017) Crit Dec Emerg Med 31(2): 16-7

Surgical Staplers (C0038938)

Definition (UMD) Staplers designed to deliver staples to join internal tissues of the body during surgical procedures. These staplers usually deliver U-shaped staples that are conformed into a B shape as they are driven through the tissue; the staples may be delivered one at a time or simultaneously, typically as a set of double staggered rows either following a linear or circular pattern. Surgical staplers are mostly used to close internal organs, for anastomosis in gastrointestinal and vascular procedures, for biopsy or wedge resection of the lung, and in other thoracic surgical procedures.
Definition (NCI) A medical instrument designed for mechanical fastening of soft tissues (e.g., closing of incisions or wounds) by delivering staples into the tissues. These devices usually consist of a mechanism for delivering staples and a disposable cartridge containing the staples.
Definition (SPN) A manual surgical instrument for general use is a nonpowered, hand-held, or hand-manipulated device, either reusable or disposable, intended to be used in various general surgical procedures. The device includes the applicator, clip applier, biopsy brush, manual dermabrasion brush, scrub brush, cannula, ligature carrier, chisel, clamp, contractor, curette, cutter, dissector, elevator, skin graft expander, file, forceps, gouge, instrument guide, needle guide, hammer, hemostat, amputation hook, ligature passing and knot-tying instrument, knife, blood lancet, mallet, disposable or reusable aspiration and injection needle, disposable or reusable suturing needle, osteotome, pliers, rasp, retainer, retractor, saw, scalpel blade, scalpel handle, one-piece scalpel, snare, spatula, stapler, disposable or reusable stripper, stylet, suturing apparatus for the stomach and intestine, measuring tape, and calipers. A surgical instrument that has specialized uses in a specific medical specialty is classified in separate regulations in Parts 868 through 892.
Definition (MSH) Fastening devices composed of steel-tantalum alloys used to close operative wounds, especially of the skin, which minimizes infection by not introducing a foreign body that would connect external and internal regions of the body. (From Segen, Current Med Talk, 1995)
Concepts Medical Device (T074)
MSH D013528
English Stapler, Surgical, Staplers, Surgical, Surgical Stapler, Surgical Staplers, STAPLER, SURGICAL, STAPLERS SURG, SURG STAPLERS, SURG STAPLER, STAPLER SURG
French Agrafeuse chirurgicale, Agrafeuses chirurgicales, Pinces anastomotiques
Swedish Kirurgiska häftmaskiner
Finnish Haavahakaset
Japanese 外科用ステープラー, 外科用ステープル, ステープラー-外科用
Italian Cucitrici chirurgiche a punti metallici, Cucitrice chirurgica a punti metallici
Czech chirurgické staplery
Polish Staplery, Zszywarki chirurgiczne, Narzędzia do zakładania szwów
Norwegian Kirurgisk hudstifter, Kirurgiske stiftemaskiner, Kirurgisk stiftemaskin, Hudstapler
German Chirurgische Nahtgeräte, Nahtgeräte, chirurgische
Dutch Chirurgische nietmachine, Nietmachine, chirurgische
Portuguese Grampeadores Cirúrgicos
Spanish Engrapadoras Quirúrgicas
Derived from the NIH UMLS (Unified Medical Language System)

Closure by staple (C0185012)

Definition (SCTSPA) Cierre efectuado con grapas
Definition (SNOMEDCT_US) A closure done by stapling
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 129375000, 50015006
LNC LA19077-9
English Stapling, Stapling - action, Insertion of staple, stapled, stapling, Stapling - action (qualifier value), Staples, Closure by staple (procedure), Closure by staple
Spanish engrapado (acción), engrapado - acción (calificador), cierre con grampas, cierre con grapas, cierre con sutura mecánica (procedimiento), cierre con sutura mecánica, sutura mecánica
Derived from the NIH UMLS (Unified Medical Language System)

Staple, Surgical (C0524724)

Definition (UMD) Small pieces of thin metallic wires, typically U-shaped, that are appropriate for mechanically fastening tissues together. Most staples are made of stainless, non-absorbable, biocompatible metals (e.g., stainless steel, chromium, titanium) or metallic alloys; they are available in several different shapes and calibers according to the intended use (e.g., bone, vessel, skin). Staples are used in surgery to join many types of organs and tissues, especially in the anastomosis of tubular structures such as the gastrointestinal tract and vasculature; other staples are used for skin wound closure. Most staples are delivered using dedicated instruments (e.g., staplers, drivers). Stapling is generally faster and produces less tissue trauma than standard suturing techniques.
Definition (NCI) A fastening device consisting of a bent wire designed to pierce and hold.
Concepts Medical Device (T074)
MSH D013537
SnomedCT 56353002, 360074000, 386014009
English Staple Device Component, Staples, Surgical, Surgical Staple, Surgical Staples, Staples, STAPLES SURG, STAPLE SURG, SURG STAPLES, SURG STAPLE, Staple, device, surgical staple, staples surgical, staples, staple, surgical staples, Staple (physical object), STAPLE, Staple, Staple, device (physical object), Surgical staple (physical object), Surgical staple, Staple, NOS, Staple, Surgical
German Chirurgische Klammer, Klammern, chirurgische, Chirurgische Klammern
French Agrafe chirurgicale, Agrafes chirurgicales
Italian Punto di sutura chirurgico, Punti di sutura chirurgici
Czech chirurgická svorka, svorky chirurgické
Spanish grapa (objeto físico), grampa (objeto físico), grampa, grapa quirúrgica (objeto físico), grapa quirúrgica, grapa, Grapas Quirúrgicas
Norwegian Hudklips, Agraff, Agraffer
Dutch Nietjes, chirurgische
Portuguese Grampos Cirúrgicos
Derived from the NIH UMLS (Unified Medical Language System)

Staplers, Skin (C1139837)

Definition (UMD) Staplers designed to deliver staples one at a time across cut skin edges to close the incision. These staplers usually deliver U-shaped staples that approximate and evert the edges of the tissue as the staples are driven through the skin and conformed into a rectangular shape. The rectangular configuration of the staples resist rotation while avoiding compression of the skin, resulting in easy removal with good cosmetic results. Skin staplers are intended to close the skin after surgical or traumatic wounds with less pain and better results than obtained with standard sutures; they are available as single-use disposable devices and also as reusable devices with disposable cartridges..
Concepts Medical Device (T074)
English Skin Staplers, Staplers, Skin, skin stapler, skin staplers
Derived from the NIH UMLS (Unified Medical Language System)

Staples, Skin (C1139841)

Definition (UMD) Staples designed to join cut skin edges. These staples are usually U-shaped metallic wires that are conformed into a rectangular shape as they are driven into the tissue to properly approximate and evert the border of the incision and allow easy removal. Skin staples are typically delivered by staplers one at a time, following a very different pattern than that used in internal surgery and avoiding tissue compression for better cosmetic results; they are usually available in two sizes, regular and wide (3.5 mm and 4.2 mm width, respectively).
Concepts Medical Device (T074)
English Skin Staples, Staples, Skin
Derived from the NIH UMLS (Unified Medical Language System)

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