Metallic biomaterials in soft tissue fixation: Applications in wound closure, tendon repair, and vascular ligation

Metallic surgical closure devices are widely used in wound closure, tendon repair, and vascular ligation due to their superior mechanical strength, stability, and durability compared to polymeric alternatives. Non-absorbable metals such as stainless steel, titanium, silver, and Nitinol provide reliable long-term fixation. In contrast, bioabsorbable metals, including magnesium, zinc, and iron, have emerged as promising alternatives that degrade after fulfilling their function, thereby reducing the need for secondary removal procedures. Despite their advantages, both permanent and bioabsorbable metallic devices require further optimization in biocompatibility, mechanical performance, and surface modifications to minimize foreign body reactions, reduce device-related complications, and improve integration with surrounding tissues. For bioabsorbable metals, key challenges include controlling degradation rates, avoiding excessive hydrogen release in magnesium-based devices, and enhancing structural integrity during the healing process. This review provides a comprehensive comparison of metallic surgical closure devices, with particular focus on sutures, staples, clips, screws, tags, and plugs, examining their applications, advantages, and limitations, as well as material selection and technological innovations that could improve clinical performance. • Metals outperform polymers in strength and durability for surgical closure. • Sutures offer precision, while staples and clips allow faster, lower-risk closure. • Stainless steel, Ti, and Nitinol dominate non-absorbable surgical fixation devices. • Mg, Zn, and Fe show promise for absorbable implants but need optimized degradation. • Future research should improve safety, stability, and imaging of metal closure devices.