laceration repair - glue vs staples vs sutures

see also:

• paediatric lacerations
• tetanus prophylaxis
• plastic surgery
• the injured hand
• other resources:
  • Wound Management in the Emergency Department by Hartmut Gross (pdf)

• staples are useful where a cosmetic result is not critical and are particularly useful for scalp lacs where healing time and cosmetic outcomes are similar to suturing while being faster, cheaper and potentially avoiding painful LA injections
• the main advantage of staples are that they are much faster than suturing and thus can potentially avoid painful local anaesthetic injections, especially in the scalp, however, the staples ARE PAINFUL and so a topical local anaesthetic such as LET should be applied if the patient is likely to not cope with the pain.
• contraindications to staples
  • cosmetic repair required such as on face or neck
  • hands or feet as the staples are uncomfortable
  • patient likely to need CT scan of that region, or an MRI scan
• usage
  • apply topical aenaesthesia such as LET gel and give it time to work
  • clean wound, irrigate and assess suitability, ensuring there are no retained foreign bodies
  • keep hair away from wound by applying lubricant and moving it away, or if needed, use scissors to allow access to wound (do NOT shave as these increases wound infection risk)
  • as the stapler tends to invert the skin edges you need to EVERT the skin edges using Adson forceps, preferably by an assistant
  • place stapler firmly on skin without indenting it
  • align the center mark of the stapler with the wound margin
  • gently squeeze the stapler trigger
  • place staples 0.5-1cm apart
• post-procedure wound care
  • can be left open if it is on the scalp, otherwise apply a dressing for 24-48hrs
  • can have a shower but avoid swimming or bathing which would soak the wound
  • remove staples with a staple remover at 7-14 days for the scalp, 7-10 days for trunk and arms, and 10-14 days for leg wounds.
  • delay in removal may make removal more difficult and if embedded may require some toggling to get out, or even LA and surgical removal if completely covered by skin
• staple removal procedure
  • position BOTH prongs under the staple
  • depress handle of staple remover so the middle of the staple is bent upwards and eased out of the skin