Experience with an Absorbable Subcuticular Skin Stapler For Closure of Surgical Pockets A Rapid, Safer, More Patient-Centric Skin Closure Solution Kyle J. Michaelis, M.D., F.A.C.C. Sacramento Heart & Vascular In our perpetual search for innovative patient-centric solutions which improve outcomes, productivity and efficiency in our adult diagnostic and therapeutic cardiology practice, we have evaluated the use of a novel absorbable subcuticular stapler (INSORB® Absorbable Subcuticular Skin Stapler, Incisive Surgical, Inc., Plymouth,MN) for the skin closure of surgical pockets in terms of safety, efficacy, complications, cost-effectiveness, comfort and cosmesis. Our experience has included over 50 patients. The resultant incisional closures were observed immediately postsurgery and generally at one week follow-up visits. The absorbable staples demonstrated equivalent efficacy compared to subcuticular suturing, with the speed of a percutaneous metal stapler. Closures with the absorbable subcuticular staplers were well approximated and secure with excellent immediate and sustained wound eversion, similar to a plastic surgery closure with interrupted sutures. These are comfortable, low maintenance wounds with no apparent immediate or late inflammatory reaction, as is often seen with suture, and resulted in excellent cosmesis, that is, thin, flat scars with no notable discoloration. We found the single operator technique simple, comfortable, and time efficient. Skin closure time for an incision was approximately 30-45 seconds. Our technique consists of closing the fascia with 2-0 VICRYLTM suture, and then closing the subcuticular/skin layer with the INSORB Stapler. Given that we no longer place deep supporting stitches, the INSORB Technique amounts to an approximate 1015 minute decrease in closure time for a surgical pocket, when compared to closing with suture. As there is no subcuticular suture or knots, the risk of stitch abscess is avoided entirely. In addition, the INSORB Stapler is a sharps safety device. INSORB Absorbable Staple With the INSORB Absorbable Subcuticular Skin Stapler, we appreciate the benefit of a secure, rapid, low maintenance closure that significantly reduces operative time, and is comfortable for the patient and presents a good aesthetic appearance. (note eversion) © 2018 Incisive Surgical, Inc.