Which lacerations are appropriate for adhesive closure strips (e.g., Steri‑Strips) instead of sutures?

Appropriate Wounds for Adhesive Closure Strips (Steri-Strips) vs Sutures

Adhesive closure strips like Steri-Strips are appropriate for simple, linear, low-tension lacerations under 3 cm in length that are clean, not crossing joints or mucocutaneous junctions, and where wound edges can be approximated without significant tension. 1

Ideal Candidate Wounds for Steri-Strips

Wound Characteristics:

• Simple, linear lacerations that are acute (less than 12 hours old) from blunt or sharp trauma 2, 3
• Low-tension wounds where edges approximate easily with minimal tension after deep sutures are placed if needed 1, 4
• Length under 3 cm for optimal outcomes 4
• Clean wounds that are not heavily contaminated, devitalized, or infected 2
• Superficial wounds not requiring deep tissue closure 2

Anatomic Locations:

• Facial lacerations are particularly well-suited due to excellent blood supply and rapid healing (requiring only 5-7 days of strip application) 1, 5
• Trunk, arms, and legs can be closed with strips but require 10-14 days of application, with high-tension areas needing the full 14-day duration 1

Wounds Requiring Sutures Instead

Absolute Contraindications for Strips:

• High-tension wounds where strips alone cannot provide sufficient tensile strength 1, 6
• Stellate lacerations or irregular wound edges 2
• Puncture wounds 2
• Mammalian bites 2
• Wounds crossing joints or mucocutaneous junctions 2
• Hair-bearing areas where adhesive cannot properly bond 2
• Infected or heavily contaminated wounds 2

Clinical Evidence Favoring Sutures:

• Sutures significantly reduce dehiscence risk compared to adhesive methods (RR 3.35; 95% CI 1.53-7.33), meaning the number needed to treat to prevent one dehiscence is 43 1, 7
• Compromised wound integrity situations require sutures for optimal closure 6

Comparative Performance

Cosmetic Outcomes:

• No significant difference in cosmetic appearance between Steri-Strips and sutures at 5-14 days, 1-3 months, or 9-12 months post-closure 2, 5, 3
• Both methods provide excellent cosmetic results when appropriately selected 1

Practical Advantages of Strips:

• Faster application time (1-2.5 minutes vs 5-8 minutes for sutures) 4, 3
• Lower cost compared to traditional sutures 1
• Reduced pain during application (VAS scores significantly favor strips) 2, 3
• No needle-stick injury risk 7
• No suture removal required 1

Important Caveats:

• Adding Steri-Strips to buried dermal sutures provides no additional benefit and should be avoided 1
• Premature removal risks wound dehiscence due to inadequate tensile strength development 1
• High-tension areas may require suture support as strips alone have higher dehiscence rates 6, 3

Application Requirements

For Successful Strip Closure:

• Wound edges must be completely dry before application 1
• Complete eyelid-style occlusion technique should be used, apposing wound edges together 1
• Keep wounds completely dry for 24-48 hours to allow proper adhesion 1
• Avoid ointments, creams, or lotions near strips as these loosen adhesive 1
• Daily monitoring for infection signs (increasing pain, redness, swelling, warmth, discharge) is essential 1