It wasn’t long ago that learning to sew lacerations in the ER was the most fun and useful a medical student ever felt.
Those days the choices were simple – to sew or not to sew, that was the question. Often it amounted to self-selection. The patient needed sutures or he wouldn’t be here. Wound care these days is a little more interesting as we can pick the suture color, thickness or stretchability. We can even put a wound together without sewing.
Wound closure, like most of medicine, is conceptually simple: just put things back together the way they were. One of my surgical professors used to quip: “Anatomic closure doctor, put the insides back in the inside.”
For many wounds that aren’t too deep or in the wrong place, almost anything works. Just get the skin edges back together and hold them there, and healing will occur. Medical stitches, staples, tape or glue all work quite well. After a week or so, the patient is as good as new.
Wounds in areas of greater skin tension or movement present some challenges. Cut the skin over a knuckle, and that repair will be pulled apart every time you make a fist. The chance of the wound staying closed with anything less robust than stitches is unlikely. Put that same wound on the forearm, where the skin doesn’t move much, and there isn’t a lot of tension and tape or glue will work just fine.
Steristrips are 1/8th inch fabric tapes that are used to close wounds. Nothing fancy, simply push the wound edges together and press on these tapes to hold it closed.
Dermabond or medical superglue is the latest innovation in wound closure. This is almost universally misunderstood outside the clinic or ER, which probably is a result of our normal use of superglue to fix nonliving things.
Take your basic broken toy, put a drop of superglue on the parts, and hold them tightly together, usually they stick. Wounds, however, are different. The biggest difference: they’re wet, and it is certainly tough to glue wet surfaces.
Medical superglue is never actually put in a wound; rather, it is put on a wound (outside the wound). Pinch the skin edges together, make sure they are really dry, and put a drop of glue on top of the wound. This special superglue has some tiny threads in it that make it stronger, like fiberglass. Gluing it shut also seals it up, so no bandage is needed.
So when it comes to skin lacerations, where they are is a big determinant of options.
Other determinants are the age of the patient. It is well known that almost any wound in a child can be taped or glued. Young children just don’t hold still when you point a needle at them (and why would they?); sometimes adults, too.
The opposite can occur in working adults. They actually ask to be sutured. Medical superglue or tape needs to be treated gently. No heavy use of the hand. Sutures are a much stronger repair and often allow a worker almost full use of the hand immediately.
So now you know you have choices. A good wound closure can be made using several different techniques. We can accommodate those with needle phobias, workaholics and everything in between.