What is the recommended closure method, Dermabond (2-octyl cyanoacrylate) or sutures, for a small laceration in the interdigital web space between the 4th and 5th fingers?

From the Guidelines

For a small laceration in the web space between the 4th and 5th digits of the hand, sutures are generally recommended over Dermabond. This location experiences significant movement and tension during normal hand use, which can compromise the integrity of tissue adhesives like Dermabond. According to a recent Cochrane review 1, there is low-quality evidence that sutures are significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence).

Key Considerations for Wound Closure

• Use 5-0 or 6-0 non-absorbable sutures such as nylon or polypropylene, removing them in 7-10 days.
• Before suturing, thoroughly clean the wound with normal saline or antiseptic solution.
• Consider a digital nerve block with 1-2% lidocaine (without epinephrine) for pain control.
• After closure, apply a non-adherent dressing and consider buddy-taping the 4th and 5th fingers to limit movement during initial healing.

Post-Closure Care

• Instruct the patient to keep the area clean and dry, avoid soaking the hand, and watch for signs of infection.
• Web spaces are prone to maceration and infection due to moisture retention, making proper wound care crucial.
• These areas contain important neurovascular structures, so careful suture placement is essential to avoid damage to underlying structures. The Cochrane review 1 also found that there was no evidence of a difference for either sutures or tissue adhesives in terms of infection, patient and operator satisfaction, and cost. However, given the specific location and potential for movement and tension, sutures remain the preferred choice for minimizing dehiscence and ensuring optimal wound healing.

From the Research

Laceration Repair in the Web Space

• The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection 2.
• Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas 2.
• The use of dermabond (a type of tissue adhesive) or sutures in the web space between the 4th and 5th digit is not explicitly mentioned in the provided studies.
• However, it is mentioned that wounds in low-tension skin areas can be effectively closed with tissue adhesives and wound adhesive strips 2.
• The web space between the fingers is considered a low-tension area, but the specific location between the 4th and 5th digit may require careful consideration of the closure method.

Considerations for Closure Method

• The choice between dermabond and sutures may depend on the size and depth of the laceration, as well as the patient's overall health and medical history.
• There is no direct evidence in the provided studies to support the use of dermabond over sutures or vice versa in the web space between the 4th and 5th digit.
• Studies have shown that topical cyanoacrylate skin adhesives (such as dermabond) offer many advantages over traditional wound closure devices, including ease of use and reduced risk of infection 3.
• However, the use of dermabond in the web space between the fingers may require careful consideration of the potential for skin irritation or allergic reactions.