The challenge of closing a surgical incision requires balancing strong, secure tissue approximation with promoting optimal healing. Surgeons must choose the most effective method for each wound, using either sutures (stitches) or surgical staples. This decision is a calculated choice based on the wound’s location, the type of tissue involved, and the required speed of closure.
The Mechanics of Wound Closure
Sutures rely on a needle and thread system woven through the tissues on either side of the incision. The threads, made from materials like silk or synthetic polymers such as nylon, are tied with a secure knot to hold the wound edges together. Sutures come in non-absorbable versions that require later removal, and absorbable types that the body naturally breaks down over time.
Surgical staples are specialized metal fasteners, typically composed of biocompatible materials like titanium or stainless steel. A dedicated stapling device rapidly fires and deforms the staple, bending it into a precise “B” shape to bridge the wound edges. While this mechanical application is often used externally on the skin, specialized staplers can also be used deep inside the body for internal closures.
Clinical Selection Where Speed and Strength Matter
The primary justification for choosing staples is the advantage they offer in speed and stability, especially for long incisions. A mechanical stapler can close a large wound in a fraction of the time required for individual sutures, benefiting extensive or emergency procedures. Reducing the time a patient spends under general anesthesia is important for improving overall surgical outcomes.
Staples provide a strong, uniform closure useful in areas under high mechanical stress or tension, such as the scalp or orthopedic surgery incisions. Specialized staplers are also used for internal procedures, such as anastomosis, which joins two segments of the intestine or other organs. In these internal applications, the stapler secures the tissue and acts as a temporary hemostat, compressing blood vessels to control bleeding at the cut site.
Clinical Selection Where Precision and Cosmesis Matter
While staples offer efficiency, sutures remain the preferred method when high precision and minimized cosmetic impact are required. Sutures allow the surgeon to meticulously control the tension and spacing between individual stitches, which is necessary for aligning delicate tissues perfectly. For highly visible areas, such as the face or neck, fine sutures are used because they promote a much finer, less noticeable scar line.
Sutures are suited for creating a layered closure, where the surgeon closes distinct planes of tissue deep beneath the skin’s surface, such as the fascia or deep dermis. This deep-layer closure helps relieve tension on the outer skin layer, which reduces the final scar width. Surgeons often use absorbable synthetic sutures, such as those made from polyglycolic acid, for these internal layers, eliminating the need for later removal.
Differences in Healing and Aftercare
External staples must be removed with a specialized tool, a quick process that often occurs 7 to 14 days after surgery. If staples are left in place for too long, they can impress small marks into the skin, sometimes described as a “railroad track” pattern, which contributes to a more noticeable scar.
Well-placed sutures, especially those beneath the skin and removed promptly, generally lead to a more aesthetically pleasing, thinner scar line. For external non-absorbable sutures, removal involves simply snipping the thread, while internal absorbable sutures dissolve naturally. While both methods are safe, some studies suggest staples may carry a slightly higher risk of superficial wound infection in certain orthopedic procedures, though reduced operative time with staples can lower overall surgical risks.