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Mattick et al report their comparison of tissue adhesives and adhesive strips and describe them as equally effective “no-needle” alternatives for the closure of suitable paediatric lacerations.1 Previous reports in the literature include a controlled trial comparing sutures, tape, and octylcyanoacrylate tissue adhesive for skin closure by Shamiyeh et al that showed no significant difference between the methods, but a comment that scars tended to be slightly wider in the non-suture groups.2 Quinn et al conducted a randomised trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations, again showing no significant cosmetic difference.3
The use of tissue adhesive and adhesive stips for wound closure is now common place in many emergency departments, though each have their limitations and practical difficulties. I wish to describe a simple technique of the combined use of these two methods for wound closure. An example scenario for this technique is where a wound can be manually held together with little tension but where there is concern that wound edge separation may occur after initial closure.
The wound edges are approximated and then held with one or more adhesive strips. The wound is then be reinforced by application of the tissue adhesive between and over (through) the adhesive strips. Alternatively, a wound that will not stay closed initially with adhesive strips alone may be closed by application of tissue adhesive to the underside of one end of an adhesive strip, allowing this to adhere to the skin on one side of the wound, before sticking the other end down in a similar manner holding the wound closed. The wound edges can be reinforced with further strips or tissue adhesive as previously described.
I have found this method, initially seen in Belfast, Northern Ireland, to be extremely useful in securing wound closure efficiently and painlessly, especially in children.
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