Comparison of incision closures with subcuticular and percutaneous staples.
OBJECTIVE
Incision closures should yield safe, effective healing with excellent cosmesis. Subcuticular absorbable staples may combine the advantages of subcuticular suturing with the efficiency of percutaneous stapling. This study compares absorbable subcuticular staples with percutaneous metal staples as a means of incision closure in facial rejuvenation surgery.


METHODS
Sixteen patients undergoing endoscopic eyebrow-lift and/or rhytidectomy were studied. Each patient had 50% of their temporal and postauricular skin incisions closed with subcuticular staples oversewn with 5-0 plain gut and the remaining 50% closed with percutaneous metal staples. Incisions were evaluated intraoperatively and at regular intervals for 1 year postoperatively. Intraoperative assessments included device handling, bleeding, tension, and cosmesis. Postoperative assessments included incision integrity, inflammation, and cosmesis. Patients were also interviewed regarding incision appearance and comfort.


RESULTS
During the early postoperative period, metal staples produced greater incisional erythema and crusting. Subcuticular staples produced better tissue eversion, less erythema, equivalent if not superior comfort, and shorter office visits. These differences faded over time. The need to properly engage the subcuticular stapler in the dermis was the principal impediment to optimal stapler use.


CONCLUSIONS
Subcuticular staples represent a safe, comfortable, and potentially more rapid alternative to percutaneous staples. Modifications of the subcuticular stapler device are required before its full potential can be realized.
Dresner
Harley S
HS
Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA. dresn001@umn.edu
Hilger
Peter A
PA
D020341:Absorbable Implants; D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D006801:Humans; D008670:Metals; D008875:Middle Aged; D011091:Polyesters; D015361:Rhytidoplasty / Q000295:instrumentation*; D017792:Surgical Stapling / Q000379:methods*; D013537:Sutures; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing
D008670:Metals; D011091:Polyesters; C033616:poly(lactide)