Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Staples versus sutures: which is superior for closure of scalp wounds? (1333)

Harrison Theile 1 , Nathan Schaefer 1
  1. Queensland Health, Brisbane, QLD, Australia

Background: Scalp wounds are a common presentation in the emergency department and for many different surgeons operating in the head and neck. Closure using sutures or staples has long presented a conundrum. While sutures are the standard of choice for most areas of the body, the scalp often lends itself to surgical staples. This literature review examines the evidence behind the relative merits of each technique.

Literature Review: Overall evidence in the area is lacking. Two prospective randomized studies were identified. Ritchie (1989)1 performed a prospective double-blind randomized trial with 200 emergency department patients with scalp wounds and found no difference in morbidity or wound infections between sutures and staples; however, staples were significantly faster, less painful and carried no risk of needle-stick injury and hence were preferred. In the paediatric population (n=88), similar results were found by Kanegaye and colleagues (1997)2, with staples the significantly faster and less expensive option over suturing in their prospective randomized study. A recent survey of American Mohs’ surgeons (Neill et al. 20203) found staples were more commonly used on the scalp due to preferable speed of closure, and equivalent complications, cosmesis and patient satisfaction to sutures. Whilst preservation of hair follicle units is another purported anecdotal benefit of staples, no research has yet been done to support this claim.

Conclusion: The limited available evidence supports the use of staples for scalp wounds, given their greater speed and cost efficiency over traditional sutures, with equivalent healing rates, infection and cosmesis. Their relative effect on hair follicle preservation remains uncertain and a topic for further research.

  1. 1. Ritchie AJ, Rocke LG. Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial. Injury. 1989 Jul;20(4):217-8. doi: 10.1016/0020-1383(89)90116-2. PMID: 2592097.
  2. 2. Kanegaye JT, Vance CW, Chan L, Schonfeld N. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. J Pediatr. 1997 May;130(5):808-13. doi: 10.1016/s0022-3476(97)80025-x. PMID: 9152292.
  3. 3. Neill BC, Seger EW, Rickstrew JJ, Rajpara A, Hocker TLH. Scalp wound closures in mohs micrographic surgery: a survey of staples vs sutures. Cutis. 2020 Aug;106(2):96-99. doi: 10.12788/cutis.0039. PMID: 32941555.
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