Stitches and staples





Definition

Stitches and staples are two methods by which a wound may be closed. Stitches use specialized needles and thread to "sew" a wound closed. Staples are thin pieces of metal that are placed with a stapling device through the edges of a wound to hold it closed.


Description

Wounds to the skin, fat, muscle, blood vessels, and other structures in the body may occur accidentally (as in a cut) or purposefully (as in a surgical incision). A number of different methods exist to close a wound; the method selected depends on the type of injury, the type of tissue injured, the location and depth of the injury, and the patient's health. Stitches and staples are two commonly used wound closure methods.


Stitches

Sutures, as stitches are often called, are the way that most wounds are closed. Suture materials have various characteristics that determine their use. The two main components of suture materials are the needle and thread.

MATERIALS. Suture thread is often characterized by how long it retains its strength in tissue. Absorbable stitches lose their strength in a matter of days or weeks and are eventually absorbed by the tissue. This characteristic is useful for the suturing of subcutaneous tissues. Nonabsorbable stitches retain their strength for months to years and may never be absorbed by the tissue. They are generally used for skin and removed once the wound has sufficiently healed. Suture thread is made of various natural or synthetic components and comes in different diameters for use in different types of tissues. Very fine suture threads are used to close cuts on the face, while threads with a larger diameter are required for subcutaneous tissues.

Suture needles may resemble a conventional sewing needle with an eye through which suture material is threaded, or they come with suture thread attached at one end; this connection is called a swage. Needles may be straight or curved; the most commonly used shape is the semicircle, which permits easier manipulation through tissues by the clinician. Needles vary in length from less than 0.1 in (2 mm) to 2.4 in (60 mm). The point of a needle may be cutting (for such tougher tissues as the skin), rounded (for such easily penetrable tissues as the subcutaneous layers), or blunt (for such easily damaged tissues as the liver).

TECHNIQUE. While various stitching techniques may be used depending on the location of the wound and type of tissue to be sutured, basic suturing technique remains the same. Several instruments are necessary for proper wound closure, including dissecting scissors (for cleaning the wound); suture scissors (for cutting suture thread); a needle holder (for manipulating the needle); and forceps (for manipulating tissue). Wounds resulting from an injury must be cleaned before closure; dead tissue and foreign bodies are removed and the area is cleansed with an antiseptic. Sutures may be interrupted (each stitch is separately placed, tied, and cut) or continuous (one continuous piece of thread composes all the stitches); they may be placed at different angles and depths.

Nonabsorbable stitches should be removed several days to weeks after their placement, depending on their location. For instance, sutures on the face should be removed in approximately 5 days; sutures on the legs and abdomen, in 7 to 10 days; and sutures on the back, in 10 to 14 days. Strips of adhesive tape may be placed over the wound to help support the tissue while it is healing.

Staples

A distinct advantage that staples have over sutures is their quick placement—stapling is approximately three to four times faster than suturing. Staples are also associated with a lower risk of infection and tissue reaction than sutures. It is, however, more difficult to correctly align the edges of a wound for stapling, and staples generally cost more than sutures. Common locations of wounds that may be stapled are the arms, legs, abdomen, back, or scalp; wounds on the hands, feet, neck, or face should not be stapled. Additionally, staples may be used to connect cut ends of larger blood vessels or segments of the bowel.


MATERIALS. Individual staples are composed of stainless steel and have a crossbar that lies parallel to the skin, two legs that enter each edge of the wound, and tips that hold the staple in place. Staples are placed with the aid of a stapling device that generally holds between 5 and 25 staples. Forceps are also necessary to help align the edges of the wound together and hold them in place until staples can be placed.


TECHNIQUE. The wound is first cleaned of dead tissue and foreign bodies and washed with an antiseptic. The edges of the wound are aligned and held together with forceps or the clinician's fingers. The stapling device is held against the wound at the point at which the staple is to be placed. By squeezing the trigger on the stapling device, the staple is automatically placed into the skin; the depth of placement is controlled by how hard the stapling device is held against the skin. The staples should be removed in approximately the same time as sutures; this is done with a specialized staple remover.


Resources

BOOKS

Lammers, Richard L., and Alexander T. Trott. "Methods of Wound Closure." In Clinical Procedures in Emergency Medicine. Philadelphia: W. B. Saunders Company, 1998.

Polk, Hiram C., William G. Cheadle, and Glen A. Franklin. "Principles of Operative Surgery." In Sabiston Textbook of Surgery. Philadelphia: W. B. Saunders Company, 2001.


OTHER

Doud Galli, Suzanne K. and Minas Constantinides. "Wound Closure." eMedicine. January 29, 2002 [cited April 29, 2003]. http://www.emedicine.com/ent/topic35.htm .

Lai, Stephen Y. "Sutures and Needles." eMedicine. September 10, 2001 [cited April 29, 2003]. http://www.emedicine.com/ent/topic38.htm .

Terhune, Margaret. "Materials for Wound Closure." eMedicine. March 13, 2002 [cited April 29, 2003]. http://www.emedicine.com/derm/topic825.htm .


Stephanie Dionne Sherk

User Contributions:

paul madden
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Aug 21, 2008 @ 11:11 am
Duse it hurt when it is time to remove the Staples
S girl
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Oct 30, 2008 @ 10:22 pm
No. It does not hurt when the staples are removed. It is a simple thing and not painful at all. It is very quick also. Nothing to worry about
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Jan 11, 2011 @ 1:13 pm
How Long Do You have to wait to wash your Hair when you have staples in the back of your head.. ?
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Jun 9, 2011 @ 12:00 am
I have had my head stapled recently and it took 11 days before the staples were removed and it was extremely painful...
Nick
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Jun 24, 2011 @ 7:07 am
I just had 32 staples removed from my arm yesterday. It was very painful and the wound is still oozing stuff.
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Jun 27, 2011 @ 9:09 am
I HAD MY GALL BLADDER REMOVED 18TH APRIL, I HAD STAPLES WITH WERE REMOVED BUT HAVE LUMPS AT THE END OF THE WOUND IS THIS NORMAL? VICKI
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Jul 6, 2011 @ 12:12 pm
My wife had a surgery one month ago(arthroscopy)in the right shoulder. The hospital charged us US$1,200 only for the suture, which is described in the account as "Suture Grasper 60ยบ Ref 251723 - Depuy" .
These are golden stitches?
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Sep 2, 2011 @ 10:22 pm
WhaT TYPE OF THREAD AND NEEDLE WORKS BEST FOR SUTURING LIKE A HAND OR LEG WOUND?
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Nov 5, 2011 @ 7:07 am
I want to know about the stitch per inch details. If ti differ to natural and synthetic sutures?
s
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Jun 17, 2012 @ 4:04 am
Nick sounds like your arm is infected!! You may need to go back to your doctor for antibiotics
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Sep 5, 2012 @ 7:07 am
My mom just had staples done on her laparotomy wound. I hope they wont be painful while removing.
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Sep 10, 2012 @ 1:13 pm
What kind of tool do they use to remove staples and is it a painful process?Is any kind of sedation required for this procedure?
Jeff
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Dec 15, 2012 @ 3:03 am
I think staples are being used more and more because surgeons are getting lazy! Look at a wound after stiches, and look at a wound after stapled. The stapled wound is ugly and the stiched would looks, well, not 100% but MUCH better than the stapled wound. It takes skill to suture a wound! I have never had surgery, but my wife has. I will NEVER sign a consent form allowing staples if I ever get surgery. We done fine for decades with regular stiches! My body will not be scarred because a lazy surgeon wants to hurry back to his extravagant lifestyle!
Art
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Apr 17, 2013 @ 12:00 am
Had open gallbladder surgery 2weeks ago staples removed today it takes 2-3 minutes absolutely no pain during staple removal.
Cerise
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Oct 4, 2013 @ 12:00 am
Hi, I'm 20 years old and I just had a brain tumour removed, about 12 days ago. I had 40 staples in the back of my head. They took half of them out yesterday, and the rest come out tomorrow. They don't hurt, except the nurse pinched my skin and it bled a little but it's fine :) It took some strategic shampooing with the help of my mother (to avoid the staples getting wet.) and you just have to avoid getting the staples wet. Basically, my head was over the sink and my mother was shampooing my hair for me ahaha. Just be patient, there isn't any nasty scaring with the staples.
Miek
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May 19, 2014 @ 10:22 pm
So Are You Not To Wash Your Hair When You Have Staples In It, Because One Of The Doctors At Baptist Hospital In Columbia SC, Told Me I Can Wash My Hair After 24Hours, Because The Wound Would Be Closed Then?
Bridget
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Aug 9, 2014 @ 3:03 am
Staples aren't necessarily used because of laziness Jeff and I don't believe there's a section on consent forms where you can request the type of wound closure you want, so that is just ridiculous to me. I've personally had both staples and stitches and the same operation done twice, the first time with stitches, second with staples. Staples have a much stronger hold and are used in particular for long wounds and wounds in an area of high movement, they offer an equal pressure and can be easily spaced, they don't however necessarily cause a worse scar, so many other factors are involved in making what a scar looks like and more often it's the stitches being stitched too tight or too loose, not evenly spaced, busted open because of the area of the wound being moved. I've seen terrible scars much worse caused by stitches than staples being a nurse, staples also are usually easier to remove and don't cause the patient too much discomfort as stitches can, staples are also easier to been seen and don't break therefore making the whole foreign body easily removed where as stitches can break and can be mistakenly left behind causing more infection potentially. Also most surgeons don't close wounds anymore and haven't done for decades so it's not laziness attributed by them, they have registrars, assistants and closing nurses to finish the job, so really each wound is closed with the most appropriate method for the situation! You should really see what a scar from a wound needing over 100 stitches looks like, it's far less prettier than what staples do to it!

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