Skin Staplers: Do You Want Them in Your Medical Kit?

The early morning after my 43^rd birthday found me in the local emergency room with excruciating abdominal pain.  After being administered some joy juice, an imaging test (hey, I don’t remember much—the joy juice was nice) revealed that gallstones and a gallbladder infection were the causing the pain.  And then the kindly doc says, “But your real problem is….” (In case you were wondering, those are words you never want to hear.) One day later I was in surgery to have my gallbladder, spleen, and most of my pancreas removed.  Basically, I was gutted like a fish, the dream of becoming a bikini model forever dashed.  Not only do I sport a massive scar from the cutting and gutting, but there are also about 60 little scars from each of the staples used to put me back together. 

In both the off-grid medicine classes I attended and in forum discussions on the internet, when it comes to supplies and equipment to have in the medical kit, skin staplers are always mentioned.  Always.  It’s a popular topic among the same group of people who discuss chest seals and tourniquets for gunshot wounds, as if that’s all to be concerned with “when there is no doctor” becomes reality.

Whether you want them in your kit is a matter of personal preference and considering exactly what kind of situations you may find yourself in. 

The same precautions and wound debridement and cleaning as occur with sutures need to be taken when using staples.  Those topics have been previously addressed on the blog and links are provided below.

Because staples are not going to be easily replaced in a long-term collapse, they should only be used when absolutely needed.  And generally, that is going to be for a mass casualty event and/or when time is of the essence, like evacuating from a dangerous situation.  However, because staples can be placed very quickly, they may be a better choice than sutures if there is no anesthetic available. 

Staplers come preloaded with usually 35 staples.  They are disposable items intended for use on one person only.  And while suturing can be done by one person, staplers require two people—one to do the stapling (this is the unskilled labor) and one to hold the skin edges properly for correct placement of the staples (the skilled labor).  A stapler should never be used unless you also have the staple remover or tools with which to improvise.

Skin staples are generally reserved for large wounds and lacerations.  Due to scarring, they are never used on the face (unless you really want that Halloween-Frankenstein look all year round).  They are not used on the hands, feet, genitalia, or over joints.  They are best used on the scalp, torso, and fleshy parts of the arms and legs.  While they are less comfortable than sutures, they do not pass through skin tissue repeatedly with the potential for carrying microbes into the tissue and wound and they are less likely to cause tissue reactivity, so staples have those advantages. 

After the wound has been completely cleaned and prepped, the assistant uses two Adson’s or rat-tooth forceps to hold the skin.  He everts the edges slightly and moves them together.  Skin must never be inverted.  Intact skin surfaces do not adhere and grow together.  Ideally, for the best healing outcome, the upper edge of the wound will be slightly humped up and slightly open.

Using the stapler takes very little training or practice.  It is held like a garden nozzle and the contactless temperature guns used so commonly right now, except that it is pressed against the skin at a 90° angle.  The depth of the staple depends directly on how firmly the stapler is pressed against the skin.  The staple should be centered over the wound.  The person doing the stapling squeezes the trigger, releases, and moves on to the next staple.  Poorly placed staples should be removed immediately. 

Staples are left in place according to the same timetable used for sutures.  A staple remover generally comes with the stapler and is used to remove the staples.  The two prongs of the lower end are placed under the staple.  When the handles are squeezed together, the top prong will bend the staple into a “V” shape and remove it. 

If the staple remover did not come with the stapler or gets misplaced, use small hemostats to remove the staple.  Place the tips of a closed hemostat between the legs of the staple.  Open the jaw of the hemostat to spread the legs of the staple open.  Keep a finger on top the staple to prevent the staple from flying through the air and hitting someone in the eye. 

I consulted three current off-grid medicine references for this topic.  Survival and Austere Medicine, 3^rd Edition presents the most complete information of the three.  (Thanks for the correction, BCE!)  Armageddon Medicine has two sentences indicating where staples are used, but nothing on how to place them.  The Survival Medicine Handbook has about a page of text covering the placement and removal of staples, but nothing on when they should be used.  In short, staplers aren’t a critical item to have on hand, unless perhaps you are in active combat. 

Skin staplers run about $11 on Amazon and $8 at ShopMedVet.com. 

Links to related posts:

Wound Closure Options

Cleaning a Wound

Skin Washes and Disinfectants

Suturing the Skin

12 january 2021