When to Use Steri-Strips vs Sutures for Head Lacerations
For head lacerations, use sutures as your primary closure method, reserving steri-strips only for low-tension wounds where cosmetic outcome is less critical, as sutures reduce wound dehiscence by 67% compared to adhesive closure methods. 1, 2
Primary Decision Algorithm
Use Sutures When:
High-tension areas (scalp under tension, wounds crossing natural skin lines) - tissue adhesives and strips fail catastrophically in these locations with a 3.35-fold increased risk of wound breakdown 1, 2
Wounds requiring deep closure - any laceration needing layered repair mandates sutures for the deep layer, though you may consider strips for superficial approximation after subcuticular suturing 3
Contaminated or infection-prone wounds - use triclosan-coated antimicrobial sutures which reduce surgical site infection risk significantly (OR 0.72; 95% CI 0.59-0.88) 2
Wounds in hair-bearing scalp - steri-strips won't adhere properly to hair, making sutures the only practical option 4
Consider Steri-Strips When:
Low-tension linear lacerations in non-hair-bearing areas of the forehead or face where wound edges approximate easily without tension 3, 4
Pediatric patients with superficial wounds where avoiding needle trauma is prioritized and the wound meets low-tension criteria 3
After placing subcuticular absorbable sutures - strips can provide additional superficial support, though this doesn't significantly improve outcomes (mean scar width identical at 1.1mm, P=0.89) 5
Critical Evidence on Dehiscence Risk
The number needed to treat is 43 - meaning you must use sutures instead of adhesive closure on 43 patients to prevent one additional wound dehiscence 1, 2. While this seems like a small absolute risk, in the scalp where tension is inherent and dehiscence consequences are significant, this risk is unacceptable 1.
Optimal Suture Technique for Head Lacerations
When you choose sutures (which should be most of the time):
Use continuous subcuticular technique with slowly absorbable monofilament sutures (4-0 poliglecaprone or polyglactin) - this reduces superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted sutures 2
For scalp lacerations specifically, interrupted sutures are often more practical due to hair interference, but use absorbable sutures to avoid the trauma of removal in children 3
Maintain proper technique: inject lidocaine slowly with a small-gauge needle after buffering with bicarbonate to minimize pain 3
Pain Management Considerations
This is particularly relevant for head lacerations in children:
Apply LET (lidocaine-epinephrine-tetracaine) topically for 10-20 minutes before repair - this provides excellent anesthesia for open wounds 3
Tissue adhesives cause less procedural pain than sutures (significant difference on visual analogue scale), but this advantage is negated by the high dehiscence risk 6
Use absorbable sutures to eliminate the pain and anxiety of suture removal, especially important in pediatric facial wounds 3
Common Pitfalls to Avoid
Never use steri-strips alone on scalp lacerations - the combination of hair, tension, and movement makes failure nearly inevitable 4
Don't be seduced by speed - tissue adhesives are quicker to apply, but the 3.35-fold increased dehiscence risk makes them inappropriate for most head lacerations 1
Avoid the combination technique in routine cases - while combining steri-strips with sutures has been described for thin-skinned elderly patients, there's no evidence this improves outcomes in standard head lacerations (no difference in scar width or complications) 5, 7
Don't use rapidly absorbable sutures - they lose tensile strength too quickly and increase complication rates 2
Special Scenario: Thin-Skinned or Elderly Patients
In elderly patients with fragile skin where sutures may tear through tissue, consider the suture-through-steri-strip technique: apply strips first, then place sutures through both the strip and skin - the strip prevents the suture from cutting through while the suture removes tension from the strip 7. However, this is a specialized technique for difficult cases, not routine practice.
Post-Closure Care
Regardless of closure method: