Should Steri-Strips (adhesive strips) be applied before or after skin adhesive for wound closure?

Steri-Strip Application Timing with Skin Adhesive

The sequence of Steri-Strip versus skin adhesive application is clinically irrelevant because Steri-Strips do not reduce surgical site infections or improve wound outcomes when used with or without tissue adhesives, and you should prioritize sutures over adhesives for most wounds requiring closure. 1

Evidence-Based Recommendation

Primary Closure Method Selection

Choose sutures as your primary closure method rather than relying on tissue adhesives or Steri-Strips alone. 1

• Sutures significantly outperform tissue adhesives for preventing wound dehiscence (RR 3.35; 95% CI 1.53 to 7.33), meaning tissue adhesives have over 3 times the risk of wound breakdown. 2
• The number needed to treat to prevent one dehiscence when choosing sutures over tissue adhesives is 43. 3
• Continuous subcuticular sutures specifically reduce superficial wound dehiscence compared to interrupted sutures (RR 0.08; 95% CI 0.02 to 0.35). 1, 3

Role of Steri-Strips

Steri-Strips provide no meaningful benefit for infection prevention or wound outcomes. 1

• The World Journal of Emergency Surgery guidelines explicitly state that Steri-Strips do not reduce the incidence of surgical site infections (GoR 1B - strong recommendation, moderate-quality evidence). 1
• Adding adhesive strips to suture sites does not improve outcomes or reduce scar width (mean scar width 1.1 mm for both methods, P = 0.89). 3
• For cosmetically sensitive areas, there is no significant difference in cosmetic outcomes between sutures with or without adhesive strips (patient assessment scores 14.0 vs 14.7, P = 0.39). 3

When Combining Methods Is Acceptable

If you choose to use both Steri-Strips and skin adhesive despite the lack of evidence supporting this combination:

• Apply Steri-Strips over dried wound glue - this does not cause harm or reduce effectiveness of either method. 2
• This combination may provide mechanical support in thin-skinned or elderly patients where suture material might tear through fragile tissue. 4
• The technique of placing sutures through Steri-Strips prevents the suture from cutting through thin skin while the tied suture removes tension from the Steri-Strip on the epidermis. 4

Optimal Suture Selection

Use absorbable subcuticular continuous sutures with materials that retain 50-75% tensile strength after 1 week (such as 4-0 poliglecaprone or 4-0 polyglactin). 1, 3

• This extended support is the primary reason continuous sutures outperform interrupted sutures for preventing dehiscence. 1
• For high-risk or contaminated wounds, use triclosan-coated antimicrobial sutures, which significantly reduce surgical site infection risk (OR 0.72; 95% CI 0.59-0.88, P = 0.001). 3

Clinical Pitfalls to Avoid

• Do not use tissue adhesives alone in high-tension areas - they have substantially higher dehiscence risk compared to sutures. 3
• Avoid continuous tightly pulled sutures that can strangulate wound edges and compromise healing. 3
• Do not rely on Steri-Strips as your primary closure method expecting infection prevention benefits that do not exist. 1