Forehead Laceration Treatment: Tissue Adhesive vs. Plastic Surgery
For forehead lacerations, tissue adhesive (glue) is the preferred treatment over plastic surgery due to shorter procedure time, less pain, and comparable cosmetic outcomes.
Advantages of Tissue Adhesive for Forehead Lacerations
- Tissue adhesives offer significantly shorter procedure times compared to traditional suturing (3.6 vs. 12.4 minutes) 1
- Patients experience substantially less pain with tissue adhesives compared to sutures (visual analog pain scores of 7.2 vs. 18.0 mm) 1
- Cosmetic outcomes at 3 months show no significant difference between tissue adhesives and standard wound closure 2
- Forehead is an ideal location for tissue adhesive use due to good blood supply and relatively immobile skin 3
- Tissue adhesives eliminate the need for follow-up visits for suture removal 4
Patient Selection for Tissue Adhesive
- Best suited for superficial lacerations with well-approximated edges 4
- Particularly beneficial for children who may be anxious about needle procedures 5
- Can be used with confidence on larger wounds where subcutaneous sutures are needed 4
- Provides a flexible, water-resistant protective coating over the wound 4
Application Technique
- Ensure adequate lighting and patient analgesia before repair 6
- Prepare the laceration site with betadine or chlorhexidine 6
- The area to be glued needs to be dry for proper adhesion 6
- Apply the least amount of adhesive necessary to seal the wound 6
- Various application techniques include using a 30-gauge needle, wooden end of a cotton applicator, or micropipette 6
Potential Complications and Considerations
- A small but statistically significant increased risk of wound dehiscence exists with tissue adhesives (NNH 25) 2
- Erythema may be less common with tissue adhesives compared to standard wound closure 2
- Complications are rare and often related to incorrect choice of application site 5
- For patients with factors that may delay wound healing, consider traditional suturing 7
When to Consider Plastic Surgery Instead
- For complex or deep lacerations requiring layered closure 4
- When wound edges cannot be easily approximated 6
- For lacerations under high tension where tissue adhesive may not provide adequate strength 7
- In cases with significant tissue loss requiring more advanced reconstruction 4
Follow-up Care
- Tissue adhesives typically slough off naturally within 5-10 days 4
- Assess the wound for proper healing with good approximation of wound edges 7
- Monitor for absence of significant swelling, erythema, or drainage 7
- Consider applying adhesive strips (Steri-Strips) across the wound for additional support during final healing stages if needed 7