Skin staplers offer a variety of surgical, closure applications
Veterinary surgeons have largely embraced surgical stapling, especially during the past 10 years. The reasons are apparent to those veterinarians familiar with surgical stapling equipment: reduction in surgery/anesthesia time for the patient, simplicity of application and consistency in results. Some doctors have been slow to embrace surgical stapling, primarily because of the potential cost concerns associated with investing in the equipment and supplies, a lack of training experience and a limited surgical caseload in a given practice.
From my clinical experience, there are two occasions where skin staples may not be ideally suited for wound closure: closing wounds under moderate tension, and use on thin skin. Conventional tension suture patterns are better able to maintain wound closure in the face of moderate incisional tension, especially in areas where regional motion can enhance this distracting force. Thin skin does not always provide sufficient dermal thickness for the proper seating or embedding of skin staples. As a result, the skin staples have a tendency to tip or rotate, making their subsequent removal problematic. Surprisingly, skin glue applied over the staple line, can reduce or eliminate this tendency, while providing an additional "footprint" of security.In more recent years, skin staplers have been effectively used to secure skin grafts to the cutaneous tissue bordering the recipient site. The skin graft is applied over the recipient site, with its borders slightly overlapping the wound edge. Skin staples are applied while adjusting the graft tension to assure proper graft to bed contact. Skin staples also are used to secure dressings over a grafted area to prevent shifting of the dressing beneath the overlying bandage layers.
Skin staples are stainless steel in composition. As a result, they can be effectively used as internal radiographic markers when applied to the subcutaneous tissues and underlying muscle fascia after tumor resection. These metallic markers can assist the radiation oncologist in determining the margins of the surgical field and the appropriate region to irradiate postoperatively.
Vascular staplers Vascular clips are an invaluable method to rapidly ligate small bleeding vessels during surgical procedures. Improvements in the design of the disposable applicators have made their clinical use much more "user friendly." The Kendall/USSC Surgiclip units, for example, currently offered have an automatic staple loader to facilitate rapid placement of flat vascular clips.
Linear stapling devices Linear staplers apply two to four rows of fine titanium staples in a staggered configuration. Thoracoabdominal (TA) staplers apply two rows of staples; the exception is the TA-30 V-3 cartridge that seals vascular pedicles with a triple row of staples (for added security). Gastrointestinal anastomosis (GIA) staplers apply four rows of staples. The most popular GIA cartridges contain a cutting blade that divides between the second and third rows of staples during application. As a result, the GIA and TA staplers have somewhat different uses.
In combination with the GIA stapler, functional end-to-end anastomosis of the intestinal tract can be performed in dogs and the larger feline patients. Similarly, they also can be employed for cholecystoduodenostomy, cholecystojejunostomy and the Bilroth II procedures.