From the Guidelines
For facial lacerations, sutures are significantly better than tissue adhesives for minimizing dehiscence, and should be the preferred choice, especially for complex or high-risk wounds. When considering the closure of facial lacerations, the primary goal is to achieve optimal functional and cosmetic outcomes while minimizing the risk of complications such as infection or wound breakdown. According to a recent Cochrane review 1, there is low-quality evidence suggesting that sutures are significantly better than tissue adhesives for reducing the risk of wound dehiscence, with a relative risk of 3.35.
Some key points to consider when deciding between glue and sutures for facial lacerations include:
- Wound characteristics: complex, deep, jagged, or contaminated wounds may require sutures for optimal closure
- Location: wounds in mobile areas like around the mouth or eyes may benefit from sutures
- Patient factors: age, compliance, and overall health status may influence the choice between glue and sutures
- Provider experience: the decision between glue and sutures should also consider the provider's experience and comfort with each method
While tissue adhesives may offer advantages such as quick application and good cosmetic outcomes, the potential benefits of sutures in terms of minimizing dehiscence and optimizing wound healing outcomes make them the preferred choice for many facial lacerations. As noted in the Cochrane review 1, there is no evidence of a difference between sutures and tissue adhesives for outcomes such as infection, patient satisfaction, or cost. However, the risk of dehiscence is a critical consideration, and sutures should be chosen when this risk is elevated.
From the Research
Comparison of Glue and Sutures for Facial Lacerations
- The use of glue (tissue adhesive) versus sutures for facial lacerations has been studied in several research papers 2, 3, 4, 5.
- A study published in 2019 found that wound infection, dehiscence, necrosis of tissue edges, and time taken for closure were much less in cases where tissue adhesive was used compared to conventional sutures 2.
- Another study published in 2025 found that the use of GLUBRAN® Tiss 2 skin adhesive may provide a less painful and complication-free alternative to traditional wound healing with sutures for head or face lacerations 3.
- A study published in 2004 found no clinically important differences in cosmetic outcome at 9 to 12 months in patients with facial lacerations closed with rapid-absorbing gut suture, octylcyanoacrylate, or nylon suture 4.
- A study published in 2006 found that there were no differences in the overall cosmetic results among all patients in the two groups (sutures and octyl-2-cyanoacrylate) 5.
Advantages and Disadvantages of Glue and Sutures
- Tissue adhesives have several advantages over conventional wound closure techniques, including easy to use, excellent bacteriostatic property, decreased repair time, elimination of recall visits, and comparable short and long-term cosmetic outcome 2.
- However, tissue adhesives can only be used as an alternative to sutures in superficial small and tension-free skin incisions or lacerations 2.
- Sutures may provide better cosmetic results in younger patients, especially when the edges of the wound need to be adjusted 5.
Wound Healing and Management
- Wound healing is an essential process for the body to repair damaged tissue and restore normal function 3, 6.
- The assessment and management of acute lacerations require an understanding of the basic pathophysiology and management principles 6.
- Non-surgical techniques for skin closure, such as tissue adhesives, can be used in amenable wounds 6.