Stapler versus suture closure in cranioplasty: A prospective comparative study on early healing score assessment

Abstract

Background and objectives. Postoperative wound complications in cranioplasty remain a significant challenge. While both staplers and sutures are standard closure techniques, their comparative impact on early healing quality lacks objective assessment. This study aimed to compare the effectiveness of stapler versus suture closure using the validated Early Healing Score (EHS). Materials and methods. A prospective comparative study was conducted on 52 patients who underwent cranioplasty at Dr. Wahidin Sudirohusodo Hospital, Makassar, between December 2024 and May 2025. Participants were divided into two groups: stapler closure and conventional suturing. Wound healing was assessed on postoperative days 1, 3, and 5 using the EHS, which evaluates re-epithelialization, hemostasis, and inflammation. Results. The stapler group demonstrated significantly higher total EHS scores compared to the suture group at all postoperative observation points (days 1, 3, and 5; p < 0.001). Each EHS subcomponent – re-epithelialization, hemostasis, and inflammation – was significantly better in the stapler group. Inter-observer reliability was high (κ = 0.87). No major wound complications occurred in either group. Conclusion. Stapler closure significantly accelerates early wound healing compared with conventional suturing after cranioplasty, yielding superior epithelial recovery and inflammation control. The stapler technique offers clinical and procedural advantages, supporting its application in neurosurgical wound management.

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