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Best evidence topic reports
Staples or sutures for repair of scalp laceration in adults
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  1. Kerstin Hogg, Clinical Research Fellow,
  2. Simon Carley, Specialist Registrar

    Abstract

    A short cut review was carried out to establish whether staples are better than sutures for scalp wound repair in adults. Altogether 42 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

    http://dx.doi.org/10.1136/emj.19.4.327-a

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      Report by Kerstin Hogg,Clinical Research Fellow 
 Search checked by Simon Carley, Specialist Registrar

      Clinical scenario

      An elderly lady is admitted to the emergency department after collapsing in the street. She has a 3 cm laceration in the left parietal area. Neurological examination and skull radiograph are normal. You have examined and cleaned the wound, but wonder whether staples would be a better option than sutures for wound closure.

      Three part question

      In [adults with scalp laceration] are [staples better than sutures] for [ease of application and patient comfort]?

      Search strategy

      Medline 1966–04/02 using the OVID interface and Cochrane Library, Issue 1 2002. Medline: [(exp Sutures OR sutur$.mp OR exp Suture Techniques OR stitch$.mp) AND (exp Surgical Staplers OR exp Surgical Stapling OR stapl$.mp) AND (exp Scalp OR scalp.mp OR exp Craniocerebral Trauma OR head.mp OR head injur$.mp)]. Cochrane: (SURGICAL-STAPLERS*:ME) AND (SUTURES*:ME).

      Search outcomes

      Altogether 42 papers found of which 39 were irrelevant. One additional paper was identified from a reference (see table 8).

      View this table:
      Table 8

      Comment(s)

      There have been no large studies looking at the advantages of stapling wounds. It seems that stapling is cheaper than suturing, but the above studies have used a variety of different parameters to estimate cost. There are no large prospective, randomised studies targeting adults with scalp lacerations, assessing patient comfort, ease of application and risk of needlestick injury.

      CLINICAL BOTTOM LINE

      Staples are a quicker and cheaper method of scalp wound closure.

      Report by Kerstin Hogg,Clinical Research Fellow 
 Search checked by Simon Carley, Specialist Registrar

      References

      1. Ritchie AJ, Rocke LG. Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial. Injury1989;20:217–18.
        OpenUrlCrossRefPubMedWeb of Science
      2. Brickman KR, Lambert RW. Evaluation of skin stapling for wound closure in the emergency department. Ann Emerg Med1989;18:1122–5.
        OpenUrlCrossRefPubMedWeb of Science
      3. MacGregor FB, McCombe AW, King PM, et al. Skin stapling of wounds in the accident department. Injury1989;20:347–8.
        OpenUrlCrossRefPubMedWeb of Science
      4. Orlinsky M, Goldberg RM, Chan L, et al. Cost analysis of stapling versus suturing for skin closure. Am J Emerg Med1995;13:77–81.
        OpenUrlCrossRefPubMedWeb of Science