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In an effort to compare time expenditures and costs of skin stapling relative to standard suturing for repair of scalp lacerations, Kanegaye and colleagues at the Children's Hospital of Los Angeles randomized children to one of the two treatment methods. Eligible patients included those with uncomplicated lacerations confined to hair-bearing areas of the scalp. Patients with wounds requiring extensive debridement or layered closures were excluded, as were patients with underlying conditions known to impede wound healing. Follow-up examination occurred at seven days following wound repair, at which time the sutures or staples were removed.
A total of 88 patients ranging in age from 13 months to 16 years were enrolled in the study, with 45 randomized to the staple group and 43 assigned to the suture group. Average wound length was approximately 2 cm, with a range of 0.4-9 cm. Wound preparation times were similar in both groups, but repair time (actual staple or suture placement) was significantly shorter in the staple group (65 vs 397 seconds; P < 0.0001). Total time (preparation + repair) was also significantly shorter in the staple group (395 vs 752 seconds; P < 0.0001). Material costs were also less in the staple group ($12.55 vs $17.59; P < 0.0001), as were total costs calculated with a physician time component. Follow-up was more than 90%. No wound complications were identified in either group.
In this study, Kanegaye et al have demonstrated what may have been intuitively obvious to many, namely that it is much more time-efficient to close simple, uncomplicated scalp lacerations with staples than with sutures. I have long been a fan of staples, which with little practice are much quicker to place than sutures, particularly in a restless child. I also find staple removal to be a bit easier than teasing out and cutting sutures placed in the hair (assuming one has the instrument available specifically designed for suture removal).
It should be pointed out that injected lidocaine was used in fewer patients in the staple group than in the suture group (52% vs 92%; P = 0.0002). Most of the remaining patients received topical anesthetic, although eight patients in the staple group received no anesthetic at all. The latter practice can be defended when only a staple or two is required to close small scalp lacerations in this case the trade-off is between the pain of lidocaine injection and that of staple placement.
Kanegaye et al state that they are not certain that their findings can be readily generalized to other settings. I would argue that their results are particularly relative to primary care settings. The combination of topical anesthetic and stapling makes it practical for office practitioners to undertake the repair of uncomplicated (the majority) scalp lacerations in the office setting. I would suspect the issues of convenience and cost savings would be viewed quite favorably by most patients and their parents. With the current move to reduce emergency department use, this effort by Kanegaye et al takes on additional importance.