Staples or sutures for repair of scalp laceration in adults
Date First Published:
October 23, 2001
Last Updated:
July 9, 2002
Report by:
Kerstin Hogg, Clinical Research Fellow (Manchester Royal Infirmary)
Search checked by:
Simon Carley, Manchester Royal Infirmary
Three-Part Question:
In [adults with scalp laceration] are [staples better than sutures] for [ease of application and patient comfort]?
Clinical Scenario:
An elderly lady is admitted to the emergency department after collapsing in the street. She has a 3cm laceration in the left parietal area. Neurological examination and skull X-ray are normal. You have examined and cleaned the wound, but wonder if staples would be a better option than sutures for wound closure.
Search Strategy:
Medline 1966-04/02 using the OVID interface, Cochrane Library 2002, Issue 1.
Search Details:
Medline: [(exp Sutures OR sutur$.mp OR exp Suture Techniques OR stitch$.mp) AND (exp Surgical Staplers OR exp Surgical Stapling OR stapl$.mp) AND (exp Scalp OR scalp.mp OR exp Craniocerebral Trauma OR head.mp OR head injur$.mp)] Cochrane: (SURGICAL-STAPLERS*:ME) AND (SUTURES*:ME)
Outcome:
Medline: Altogether 42 papers found of which 40 were irrelevant. Cochrane: 29 papers, of which 1 additional relevant paper found. 1 additional paper identified from a reference.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial. Ritchie AJ, Rocke LG. 1989, Northern Ireland | 200 patients attending A&E over a 6 month period, with scalp lacerations | Prospective randomised study | Speed of repair | Average 49 sec to close stapled wound and 6 min 20 sec to close sutured wound | 39% of patients missed the second wound review at 3 weeks Cost only takes into account price of material equipment |
| Patient discomfort | Wound repair with staples was less painful than with sutures | ||||
| Cost | £4.25 per stapled wound, £2 per sutured wound | ||||
| Wound complications | No difference in wound complications | ||||
| Evaluation of skin stapling for wound closure in the emergency department. Brickman KR, Lambert RW. 1989, USA | 76 emergency patients with scalp, trunk, and extremity lacerations | Observational study looking at stapled wounds | Time efficiency | Most wounds were closed within 30 secs | 67% of wounds were scalp lacerations 17 patients lost at 7 day follow-up 37% also contacted 6 months later Paper does not use physicians time to calculate cost, nor does it include the cost of suture kits for stapling |
| Cosmesis | One scalp wound and one leg wound dehisced | ||||
| Wound complications | Two stapled wounds dehisced | ||||
| Cost efficiency | Most wound closures with staples cost $5.11 compared to $9-$11 for suture closure | ||||
| Patient satisfaction | None were dissatisfied | ||||
| Physician satisfaction | As a new technique they found it easy and rapid | ||||
| Skin stapling of wounds in the accident department. MacGregor FB, McCombe AW, King PM, et al. 1989, Scotland | 100 consecutive patients presenting to A&E with superficial lacerations | Prospective randomised study | Speed of repair | Mean time per staple 18.6 sec, mean time per suture 124 sec | Not all lacerations involved the scalp Times included skin preparation Physicians time not used to calculate costs |
| Cost | 5 staples £4.14, 5 sutures £2.36 | ||||
| Ease of removal | No difference | ||||
| Wound complications at time of removal | No difference | ||||
| Patient acceptability | More patients found staples acceptable. No local anaesthetic applied for stapling | ||||
| Cost analysis of stapling versus suturing for skin closure. Orlinsky M, Goldberg RM, Chan L, et al. 1995, USA | Patients presenting to the emergency department with linear lacerations of the scalp, extremities and trunk | Prospective randomised study | Time efficiency | Average speed of stapling 8.3 seconds per cm, and for suturing 63.2 seconds per cm. | Unable to report wound healing outcomes as follow-up poor |
| Cost of repair | Average cost of wound repair by staple, $7.08 if no suture kit used, and $17.69 if kit used. Average cost suture repair was $21.58. |
Author Commentary:
There have been no large studies looking at the advantages of stapling wounds. It appears that stapling is cheaper than suturing, but the above studies have used a variety of different parameters to estimate cost. There are no large prospective, randomised studies targeting adults with scalp lacerations, addressing patient comfort, ease of application and risk of needlestick injury.
Bottom Line:
Staples are a quicker and cheaper method of scalp wound closure.
References:
- Ritchie AJ, Rocke LG.. Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial.
- Brickman KR, Lambert RW.. Evaluation of skin stapling for wound closure in the emergency department.
- MacGregor FB, McCombe AW, King PM, et al.. Skin stapling of wounds in the accident department.
- Orlinsky M, Goldberg RM, Chan L, et al.. Cost analysis of stapling versus suturing for skin closure.