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LETTER TO THE EDITOR Simple Method to Prevent Retention of Skin Staples

Publisher:Open Science Company, LLC
Ken Matsuda, MD, PhD, Minoru Shibata, MD, PhD, and Ko Hosokawa, MD, PhD
June 2015
LETTER TO THE EDITOR
Simple Method to Prevent Retention of Skin Staples
Ken Matsuda, MD, PhD,a Minoru Shibata, MD, PhD,a and Ko Hosokawa, MD, PhDb

aDepartment of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medicine, Niigata, Japan; and bDepartment of Plastic and Reconstructive Surgery, Osaka University Graduate School of Medicine, Osaka, Japan


Correspondence: matsuken@med.niigata-u.ac

Dear Sir,

Skin stapling devices are widely used to secure skin graft because they are easy to use and useful—especially for large grafting areas. They can save operating time and improve graft taking.1 However, if not removed at the appropriate time, stainless steel staples are easily buried in overgrown granulation tissue or epithelium, after which they are sometimes difficult to retrieve. Although buried staples do not generally result in adverse effects, they can provoke symptoms2 and result in medicolegal difficulties, as they are easily noticed in radiographs3 during long-term follow-up. Biodegradable skin staples have been developed to address these concerns4; however, the cost and inelasticity of these staples limit their utility.5 Although solutions for dealing with retained metal staples have been reported,3,5 prevention is clearly the better alternative. Skin stapling over a nonadhesive dressing material can prevent growth of tissue over staples but may result in difficulties with changing dressings and graft inspection.3 To prevent unintentional retention of staples, we staple skin grafts with 2-0 or 1-0 silk thread (Fig 1). These stapled silk threads do not interfere with postoperative dressing change or graft inspection. All staples are removed by lifting the silk thread at 1 week postoperatively (Fig 2). This method was successfully used for seven patients who underwent mesh skin grafting; no staples were retained. This simple and inexpensive method avoids the physical and medicolegal problems associated with staple retention.

Figure 1. The meshed skin graft was stapled with 2-0 or 1-0 silk thread. The ends of the silk threads were tied together to avoid accidental removal.
Figure 2. On postoperative day 7, all staples were removed by lifting the silk threads. Even on postoperative day 7, some staples were going to be buried in granulation tissue (arrow) but were easily detected because of the silk thread stapled to them.

REFERENCES

1. Sato RM, Tebbetts JB, Suarez AJ, Hunt JL, Baxter CR. Staples: their use in achieving biological coverage of burn patients. Burns. 1980;6:261-3.

2. Pape SA, Hodgkinson P. Retained skin staple. Burns. 1994;20:281.

3. Liu HL, Chung HP. A simple technique for the retrieval of buried staples. Burns. 2012;38:1086-8.

4. Himel HN, Rodeheaver GT, Luterman A, et al. A new device for securing meshed split-thickness skin grafts. Scand J Plast Reconstr Surg Hand Surg. 1994;28:299-303.

5. Sheridan R, Shapiro A, Kay D, Petras L, Lydon M. Initial experience with a prototype staple detector. J Burn Care Rehabil. 2001;22:232-4.

JOURNAL INFORMATION ARTICLE INFORMATION
Journal ID: ePlasty Volume: 15
ISSN: 1937-5719 E-location ID: e2
Publisher: Open Science Company, LLC Published: January 14, 2015