What is the preferred method for wound closure, glue or sutures?

Wound Closure: Sutures Over Glue

Sutures are significantly superior to tissue adhesives (glue) for wound closure, primarily because they reduce the risk of wound dehiscence by more than threefold. 1, 2

Primary Recommendation

• Use sutures as the first-line method for most wound closures, particularly when wound integrity and mechanical support are critical priorities 3, 1
• Tissue adhesives carry a significantly higher risk of wound breakdown (RR 3.35; 95% CI 1.53-7.33), meaning you would need to treat 43 patients with sutures instead of glue to prevent one additional dehiscence 1, 2
• For infection rates, patient satisfaction, and cosmetic outcomes, there is no significant difference between the two methods, but the dehiscence risk alone makes sutures the safer choice 1, 2

When Sutures Are Mandatory

• High-tension wounds: Tissue adhesives fail in areas where mechanical forces are significant 3, 1
• Contaminated or infection-prone wounds: Use triclosan-coated antimicrobial sutures, which reduce surgical site infection risk (OR 0.72; 95% CI 0.59-0.88) 3, 4
• Compromised wound integrity: When there are concerns about healing capacity or tissue quality 3
• Deep or complex wounds: Where layered closure or extended support is needed 5

Optimal Suture Technique

• Use continuous subcuticular sutures rather than interrupted sutures, as they significantly reduce superficial wound dehiscence (RR 0.08; 95% CI 0.02-0.35) 3, 4
• Maintain a suture-to-wound length ratio of at least 4:1 to minimize incisional hernia and wound complications 6
• Choose slowly absorbable monofilament sutures (such as 4-0 poliglecaprone or 4-0 polyglactin) that retain 50-75% tensile strength after 1 week 3, 4
• Avoid excessive tension when tying sutures, as tightly pulled sutures can strangulate wound edges and compromise healing 3

Limited Role for Tissue Adhesives

Tissue adhesives may be considered only in highly selected circumstances:

• Low-tension, superficial wounds where speed of application is prioritized and dehiscence risk is acceptable 1, 2
• Pediatric or needle-phobic patients where avoiding suture removal is a significant benefit 2
• As an adjunct to sutures (not as replacement), though adding adhesive strips to sutures does not significantly improve outcomes (mean scar width 1.1 mm for both methods, P = 0.89) 3

Common Pitfalls to Avoid

• Do not use tissue adhesives alone in emergency laparotomy or abdominal wall closures - these require proper suture technique with appropriate ratios and materials 6
• Do not assume cosmetic outcomes favor glue - there is no evidence of significant cosmetic differences between properly placed sutures and adhesives 3, 1
• Do not use rapidly absorbable sutures - they increase incisional hernia rates compared to slowly absorbable materials 6
• Recognize that glue's speed advantage is minimal and does not outweigh the threefold increase in dehiscence risk 1, 2

Post-Closure Monitoring

Regardless of closure method chosen:

• Monitor for signs of infection: increasing pain, redness, swelling, or discharge 3, 1
• Watch for wound dehiscence, particularly in the first 7-10 days 3, 4
• Remove non-absorbable sutures or staples within 7-10 days to optimize healing 4