Stitches vs Staples: What Are the Differences?

Jun. 10, 2024

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Stitches vs Staples: What Are the Differences?

How Are Stitches and Staples Used?

Stitches and staples have the same job: to close large or complex wounds or incisions that the body would not be able to on its own.

Goto Ezisurg to know more.

Surgical Staples: a Brief Rundown

Surgical staples are very similar to the staples you use for paper, but they have more variation in shape and size to compensate for the type of wound they are being used on. The most common materials for surgical staples are titanium, plastic, and polylactide-polyglycolide copolymers. Titanium is the most common, as it is the strongest of the three, but some people can have a bad reaction to titanium, which is why plastic is used. Polylactide-polyglycolide copolymer is a dissolvable material that can be used when the wound is expected to heal relatively quickly. They are applied by holding the wound closed with a pair of forceps and then using a skin stapler to insert the staples.

Stitches: The Basics

Stitches are an extremely versatile tool for doctors. They can close a variety of wounds or incisions efficiently. Stitches are available in multiple different materials, making it easy to find an option that won&#;t cause a reaction. Stitches also have multiple types of absorbable and nonabsorbable materials, allowing doctors to provide the patient with the most optimal method for recovery.

Advantages and Disadvantages of Surgical Staples

Advantages of staples:

Very sturdy, making the wound less likely to reopen.
Application is very simple, allowing doctors to close wounds quickly and efficiently
Very efficient with abdominal, uterine, organ (re)connection and removal, and closing wounds or incisions on the scalp.
Can be less painful than stitches. Because staples are stronger than stitches, doctors need to apply fewer staples than stitches. This means a smaller area of skin is being disturbed so there is usually less pain.
Can handle large wounds more efficiently than stitches.

Disadvantages of staples:

Can be harder for the patient to care for
Require a special tool to remove
Require at least two doctors to administer, one to hold the wound together, one to apply the staples
Less efficient for complex or deep wounds
The stapler can easily malfunction, causing complications
Can easily lead to complications due to improper application
More expensive
Often causes adverse psychological response

Advantages and Disadvantages of Stitches

Advantages of stitches:

More material options means a lower chance for reaction
More efficient for wounds that damage multiple layers of skin or tissue or have a complex shape
Only need a pair of scissors or to be dissolved for removal
Can be applied by a single doctor
Easier to care for
More versatile in their application
Less expensive
Fewer complications after application

Disadvantages:

Take more time to apply
Easy to break
Can be more painful
Can be less effective for large wounds
Needle stick injuries

Is One Better Than the Other?

In short, no. Both options have their own advantages and disadvantages. There are many studies that compare the efficiency of staples and stitches, and the vast majority find little to no difference between the two.

However, the FDA moved surgical staples from a Class 1 to a Class 2 medical device in October . These classes describe the risk a device has to the patient&#;s health or safety. From January 1, , to March 31, , the FDA collected over 41,000 medical device reports that detailed 366 deaths, over 9,000 serious injuries, and over 32,000 malfunctions for surgical staplers and staples used internally.

All this means for you is that if you undergo surgery that requires some form of wound closure, your doctor is more likely to use stitches. However, staples are more effective with C-sections and scalp wound closures.

Pulling it All Together

The use of surgical staples and stitches is going to come down to the doctor applying them, and the injury or procedure. As long as you are being treated by a competent doctor with properly functioning equipment and you properly care for your staples or stitches, complications are likely not going to be an issue.

Surgical staple

Staples used in surgery in place of sutures

34 surgical staples closing scalp following craniotomy Projectional radiograph of surgical staples

Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds or connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, and time it takes to close.[1]

A more recent development, from the s, uses clips instead of staples for some applications; this does not require the staple to penetrate.[2]

History
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The technique was pioneered by "father of surgical stapling", Hungarian surgeon Hümér Hültl.[3][4] Hultl's prototype stapler of weighed 8 pounds (3.6 kg), and required two hours to assemble and load.

The technology was refined in the s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and anastomeses.[4] Mark M. Ravitch brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur Leon C. Hirsch, who founded the United States Surgical Corporation in to manufacture surgical staplers under its Auto Suture brand.[5] Until the late s USSC had the market essentially to itself, but in Johnson & Johnson's Ethicon brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by Tyco Healthcare in , which became Covidien on June 29, .

Safety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.[6] It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than catgut, silk and linen, which were the main suture materials used up to the s.

One key feature of intestinal staplers is that the edges of the stapler act as a haemostat, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.[7][2]

In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leakage.[8] Alternative techniques to seal lung tissue are currently investigated.[9]

Types and applications

Are you interested in learning more about medical staplers? Contact us today to secure an expert consultation!
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Close-up demonstration of a surgical skin stapler.

The first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.

Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.

The staple line may be straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in esophagogastric surgery.[10] The instruments may be used in either open or laparoscopic surgery, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of trocar ports.

Some staplers incorporate a knife, to complete excision and anastomosis in a single operation. Staplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in vertical banded gastroplasty surgery (popularly known as "stomach stapling").

Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion &#;30°. Activating guide-wire is connected just immediately before firing (video)

While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research [11][12][13][14][15] circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.

Although most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures.

Removal of skin staples
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Where skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that, when hand-pressure is exerted, pushes the staple down through a slot in the shoe, deforming the staple into an 'M' shape to facilitate its removal. In an emergency it is possible to remove staples with a pair of artery forceps.[16] Skin staple removers are manufactured in many shapes and forms, some disposable and some reusable.