Stapling Devices (Internal Medicine)

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  • Wounds on scalp, extremities, or torso with straight, clean edges that are easily approximated
  • Effective alternative for pediatric lacerations
  • Mass casualty or multiple traumas
  • Deep wounds
  • Inadequate hemostasis
  • CT scanning is planned
  • MRI is planned
  • Lacerations on face, hands, feet
  • Wound cleaning and exploration equipment
    • Wound cleanser (e.g., sterile saline, iodine-based detergent)
    • Gauze
    • Instruments for sharp debridement, if indicated
    • Supplies for local anesthesia, including syringe, 25- to 30-gauge needle for injecting and anesthetic agent, such as lidocaine
    • Sterile gloves
  • Stapling device
    • Sterile, preloaded
    • Numerous devices for stapling are available, and practitioners should be familiar with the devices available at their institution. Most units hold 5-15 staples; for most simple lacerations that are amenable to staple closure 10 staples are usually sufficient.
  • Staple remover
  • Forceps
  • Dressing supplies
Skin layers
  • Human skin is made up of three layers, epidermis, dermis, and subcutaneous fat.
Wound healing
  • The initial phase of wound healing during days 0 to 5 is the inflammatory phase.
  • The epithelium begins healing immediately after the wound is closed.
  • Within 48 hours, the epithelium regenerates and closes off the external surface of the wound to protect it from contamination.
  • The fibroblast phase begins around 48 hours after injury.
  • Collagen production reaches its peak about 7 days later and has the most mass at 3 weeks after injury.
  • The wound will continue to strengthen over the next year.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

Wound care
  • Antibiotic ointment and a nonadherent dressing can be placed on the wound.
  • The patient should be instructed to gently clean the wound after 24 to 48 hours.
  • Staples on an extremity or the torso should be removed on day 7 to 10, and staples on the scalp, back, or over joints on day 10 to 14.
Staple removal
  • Use the staple remover to remove the staples.
  • Wound dehiscence
  • Wound infection
  • Patient discomfort
  • Scarring
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