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Forgotten staples
burns 35 (2009) 611
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Forgotten staples For many years, different modalities have been used for skin graft fixation such as: honey [1], cyanoacrylate [2], skin staples [3] and even amniotic membrane [4]. However, the method of choice in many burn centers is skin stapling which is quick and safe. Sometimes the removal of skin staples is stressful and painful for the patients so that in our center, we use amniotic membrane for skin graft fixation specially in children and the burns involving the extremities [4]. But the main reason that we decided to write this article is that sometimes, staples are left in their places incidentally during the removal procedure. As we followed 2000 grafted patients during 4 years in our burn center, in 73 patients we found forgotten staples that in 81% of the cases, the patients were symptomatic. The most common symptoms are recurrent pain and discharge at site of forgotten staples. This commonly happens at sites of partially graft loss and also when the staples are removed more than 21 days after insertion. In the cases of partially graft loss, the mechanism of wound healing (contracture and scar formation) can be the cause. So, we recommend that when the surgeon decides to remove the skin staples, removal of all the staples must be tried to do and more attention should be paid to graft loss areas because these forgotten staples may bother the patient in future.
references
[1] Ilteris Murat E. A different and safe method of split thickness skin graft fixation: medical honey application. Burns 2007;33:782–7.
§
[2] Adler N, Nachumovsky S, Meshulam-Derazon S, Ad-El D. Skin graft fixation with cyanoacrylate tissue adhesive in burn patients. Burns 2007;33:803. [3] Alexander G, Al-Rasheed AA. Skin stapler removal by artery forceps: a hazardous practice? Burns 2005;31:116. [4] Mohammadi A, Johari HG. Amniotic membrane: a skin graft fixator convenient for both patient and surgeon. Burns 2008;34:1051–2.
Ali Akbar Mohammadi Shiraz Burn Research Centre, General Surgery Department, Shiraz University of Medical Sciences, Iran Hamed Ghoddusi Johari* Nasir Fakhar Trauma Research Centre, General Surgery Department, Shiraz University of Medical Sciences, Iran *Corresponding author. Tel.: +98 917 713 1640; fax: +98 711 2330724 E-mail address: [email protected] (H.G. Johari) 0305-4179/$36.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2008.08.005
All authors have made substantial contributions to the conception and design of the manuscript.
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Forgotten staples For many years, different modalities have been used for skin graft fixation such as: honey [1], cyanoacrylate [2], skin staples [3] and even amniotic membrane [4]. However, the method of choice in many burn centers is skin stapling which is quick and safe. Sometimes the removal of skin staples is stressful and painful for the patients so that in our center, we use amniotic membrane for skin graft fixation specially in children and the burns involving the extremities [4]. But the main reason that we decided to write this article is that sometimes, staples are left in their places incidentally during the removal procedure. As we followed 2000 grafted patients during 4 years in our burn center, in 73 patients we found forgotten staples that in 81% of the cases, the patients were symptomatic. The most common symptoms are recurrent pain and discharge at site of forgotten staples. This commonly happens at sites of partially graft loss and also when the staples are removed more than 21 days after insertion. In the cases of partially graft loss, the mechanism of wound healing (contracture and scar formation) can be the cause. So, we recommend that when the surgeon decides to remove the skin staples, removal of all the staples must be tried to do and more attention should be paid to graft loss areas because these forgotten staples may bother the patient in future.
references
[1] Ilteris Murat E. A different and safe method of split thickness skin graft fixation: medical honey application. Burns 2007;33:782–7.
§
[2] Adler N, Nachumovsky S, Meshulam-Derazon S, Ad-El D. Skin graft fixation with cyanoacrylate tissue adhesive in burn patients. Burns 2007;33:803. [3] Alexander G, Al-Rasheed AA. Skin stapler removal by artery forceps: a hazardous practice? Burns 2005;31:116. [4] Mohammadi A, Johari HG. Amniotic membrane: a skin graft fixator convenient for both patient and surgeon. Burns 2008;34:1051–2.
Ali Akbar Mohammadi Shiraz Burn Research Centre, General Surgery Department, Shiraz University of Medical Sciences, Iran Hamed Ghoddusi Johari* Nasir Fakhar Trauma Research Centre, General Surgery Department, Shiraz University of Medical Sciences, Iran *Corresponding author. Tel.: +98 917 713 1640; fax: +98 711 2330724 E-mail address: [email protected] (H.G. Johari) 0305-4179/$36.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2008.08.005
All authors have made substantial contributions to the conception and design of the manuscript.