How to remove staples from a wound at home?

Staples used in surgery in place of sutures

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34 surgical staples closing scalp following craniotomy Projectional radiograph of surgical staples

Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds or connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, and time it takes to close.[1]

A more recent development, from the s, uses clips instead of staples for some applications; this does not require the staple to penetrate.[2]

History

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The technique was pioneered by "father of surgical stapling", Hungarian surgeon Hümér Hültl.[3][4] Hultl's prototype stapler of weighed 8 pounds (3.6 kg), and required two hours to assemble and load.

The technology was refined in the s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and anastomeses.[4] Mark M. Ravitch brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur Leon C. Hirsch, who founded the United States Surgical Corporation in to manufacture surgical staplers under its Auto Suture brand.[5] Until the late s USSC had the market essentially to itself, but in Johnson & Johnson's Ethicon brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by Tyco Healthcare in , which became Covidien on June 29, .

Safety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.[6] It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than catgut, silk and linen, which were the main suture materials used up to the s.

One key feature of intestinal staplers is that the edges of the stapler act as a haemostat, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.[7][2]

In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leakage.[8] Alternative techniques to seal lung tissue are currently investigated.[9]

Types and applications

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Close-up demonstration of a surgical skin stapler.

The first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.

Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.

The staple line may be straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in esophagogastric surgery.[10] The instruments may be used in either open or laparoscopic surgery, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of trocar ports.

Some staplers incorporate a knife, to complete excision and anastomosis in a single operation. Staplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in vertical banded gastroplasty surgery (popularly known as "stomach stapling").

Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion &#;30°. Activating guide-wire is connected just immediately before firing (video)

While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research [11][12][13][14][15] circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.

Although most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures.

Removal of skin staples

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Where skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that, when hand-pressure is exerted, pushes the staple down through a slot in the shoe, deforming the staple into an 'M' shape to facilitate its removal. In an emergency it is possible to remove staples with a pair of artery forceps.[16] Skin staple removers are manufactured in many shapes and forms,[17] some disposable and some reusable.

See also

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References

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What are surgical staples?

Surgical staples are used to close incisions after surgery. Staples may be a better option in some cases than stitches or sutures.

Unlike stitches, surgical staples don&#;t dissolve as your incision or wound heals. For this reason, they require some special care and must be removed by your doctor once the incision has healed.

How long do they need to stay in your body?

Surgical staples need to stay in for a few days or up to 21 days (in some cases) before they can be removed.

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How long your staples must stay in place depends largely on where they&#;re placed and other factors such as:

• the size and direction of the incision
• the type of surgical procedure you had
• the complexity or severity of your incision or wound
• how quickly the area heals

For example, after a C-section, staples used to close a low transverse (horizontal across the body) incision may be removed after three to four days. But staples used in a vertical incision may not be removable for 7 to 10 days or more.

Several indicators that your surgical staples may be ready to be removed include:

• The area has healed well enough that staples aren&#;t needed anymore and the wound won&#;t reopen.
• There&#;s no pus, fluid, or blood drainage from the area.
• There aren&#;t any symptoms of infection.

Can you remove surgical staples at home?

Never try to remove surgical staples yourself at home. Always have a licensed medical professional remove staples.

Your doctor will follow special procedures and use specific tools in order to safely remove surgical staples without causing complications.

How are they removed?

The exact staple removal procedures your doctor uses will depend on:

• where the staples are located on your body
• what type of surgery you had
• whether they&#;re used inside or outside your body

It&#;s usually not painful when your doctor removes your surgical staples. You may feel a tugging or pinching sensation as each staple is removed.

When removing your surgical staples, your doctor will follow these general steps:

1. Remove any wound dressing or other materials covering the area.
2. Look for any abnormal symptoms or issues with the wound&#;s appearance.
3. Clean and sterilize the entire area with medical antiseptics.
4. Slide the lower part of a staple extractor tool underneath the outermost staple on either side of the stapled area.
5. Wiggle the staple gently side to side until it comes out of the skin.
6. Put the staple on a clean sheet of gauze immediately.
7. Repeat steps 4 to 6 on every second staple along the area until the end of the incision is reached. You may not have all your staples removed at a single appointment if the area is not fully healed.
8. Remove all remaining staples.
9. Put a sterile strip on each area from which a staple was removed.

Some staples may stay inside your body permanently. This is often done to keep internal organ tissues connected and resistant to further damage.

When are surgical staples used?

Surgical staples are used to close surgical incisions or wounds that are too big or complex to close with traditional stitches. Using staples can decrease the time needed to complete surgery and can be less painful.

Staples may be simpler, stronger, and speedier to use to close large, open wounds than traditional stitches, and may be used after major surgery.

For example, staples are often used after C-sections because they help the incision heal faster while also reducing scar appearance.

How do I care for surgical staples?

After getting staples, the following steps will help keep them clean as you heal:

• Follow all postsurgical instructions from your doctor.
• Don&#;t remove any dressings or bandages until your doctor says it&#;s safe to do so.
• Rinse the area gently with clean water twice a day.
• Use Vaseline or petroleum jelly and a sterile bandage that doesn&#;t stick to cover the area.
• Replace bandages at least once a day or every time it gets soiled or wet.

What are surgical staples made of?

Some common surgical staple materials include:

• Titanium. Known to easily adhere to both bodily tissues and bone, titanium is less likely to cause inflammation or infection.
• Plastic. This material is used if you&#;re allergic to metals found in other surgical staples.
• stainless steel. Plastic is commonly used for staples and may help reduce scar appearance.
• Polylactide-polyglycolide copolymer. This material is easily reabsorbed into the body. It&#;s popular in plastic surgery because it&#;s less likely to leave a noticeable scar following healing.

How are surgical staples placed?

Surgical staples are placed with a special stapler.

They don&#;t look quite the one on your desk. Surgical staplers look more like commercial-grade construction staplers with a handle and lever that your doctor pushes down to place the staple.

Surgeons use these specially designed staplers to safely, quickly, and precisely place surgical staples on a wound. The process is much faster than stitching or suturing because the staples are placed instantly.

What are the risks of surgical staples?

Surgical staples do carry some risks, including:

• infection from not taking care of the wound (or from bacteria getting into the area)
• improper placement of the staples causing the wound to heal poorly or not close all the way
• wound reopening after staple removal (if staples are removed too early)
• allergic reaction to staple materials

When should I call a doctor?

Seek emergency medical attention if you notice any of the following symptoms around the area that&#;s been stapled:

• severe or new pain
• bleeding from your incision
• redness or swelling of your incision and surrounding area
• increase in the size or depth of the stapled area
• dark or dry appearance around the stapled area
• thick, bad-smelling pus or discharge colored yellow, green, or brown
• low-grade fever (100°F or higher) that lasts for four hours or more

The takeaway

Staples have a number of advantages over stitches for especially large or complex surgeries, injuries, or incisions. In some cases, they may even lower your chances of complications like infection.

Talk to your doctor before getting staples. Be sure to let your doctor know about any allergies you may have and if you&#;ve had any complications from surgical staples in the past.

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