Automatic skin staplers have been commonly used for surgical wound closure for many years. The efficiency and ease of placement of skin staplers make them an attractive alternative to suture repair of selected lacerations in the emergency department. Emergency physicians, however, have been reluctant to use staplers in the ED. We evaluated skin staples in 76 patients presenting with 87 lacerations to the scalp, trunk, or extremities, excluding hands and feet. Patients returned to the ED in two and seven to ten day for wound check and staple removal. Skin stapling was assessed for efficiency, cosmetic results, complications, and cost-effectiveness. Only one significant complication was noted in our study group - a dehiscence of a scalp laceration secondary to hematoma collection. There was also a minor dehiscence of a superficial laceration of the leg due to inadequate primary closure, which did not result in any cosmetic deformity. No infectious complications, delayed wound healing, or cosmetic problems were seen. Skin stapling was easier and quicker than suture repair at a lower overall cost in most circumstances. Our study shows skin stapling to be an efficient and cost-effective alternative method to suture wound closure for selected lacerations in patients presenting to the ED, without compromising wound healing or cosmetic results.