Lacerations comprise a significant number of emergency department referrals for pediatric patients. Management of lacerations with sutures involves the use of needles and the injection of local anesthetic and represents a unique challenge in the wound management of an already distressed and frightened child. Octylcyanoacrylate, a new-generation, medical-grade tissue adhesive, has been found to be an effective alternative to replace skin sutures on virtually all facial lacerations and has been employed in low-skin tension wound management. Its use, however, has generally been avoided in the management of high-skin tension lacerations. Over the last 10 months, 32 children with high-skin tension (hand, feet, and over joints) lacerations were managed at our center by octylcyanoacrylate tissue adhesives. Skin closures and splints were applied to restrict movement of the affected area to overcome the limitation of adhesive application. Octylcyanoacrylate adhesive applied with optimal immobilization was found to be an effective method of skin closure in high-skin tension lacerations. Advantages of tissue adhesives for incision and laceration include quick application, excellent cosmetic results, patient preference, and cost effectiveness.