JJ 22 Laceration Repair – Glue vs Strips vs Staples vs Sutures

In this Part 2 of our 3-part podcast series on management of lacerations Dr. Haley Cochrane, Dr. Justin Morgenstern and Dr. Anton Helman explore the evidence around the various methods to repair skin lacerations in the Emergency Department. In it they discover 4 themes making concrete conclusions on this topic challenging: the lack of blinding in all the studies, the subjective outcomes measured in the studies, the interplay between the multiple steps of suture repair and the effect of the skill of the provider that may impact outcomes... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman January, 2023 Cite this podcast as: Helman, A. Cochrane, H. Morgenstern, J. Journal Jam 22 Laceration Repair - Glue vs Strips vs Staples vs Sutures. Emergency Medicine Cases. January, 2023. https://emergencymedicinecases.com/laceration-repair-glue-strips-staples-sutures. Accessed September 17, 2024 Surgical skin glue for skin lacerations 2002 Cochrane review comparing skin glue to sutures 11 RCTs no differences in cosmesis advantages of skin glue: pain scores and time of laceration repair lower with glue; overall less expensive disadvantages of skin glue: skin glue more likely to have short term localized erythema and rate of dehiscence is 2% higher Adding adhesive strips ("steri-strips") to skin glue doubles the tensile strength as compared to using either alone. Hair apposition technique for scalp lacerations 1 RCT - the HAT trial comparing hair apposition technique to sutures 189  patients with scalp lacerations 3-10 cms excluded patients requiring resuscitation, with arterial bleeds and with significant contamination hair apposition 5 mins vs sutures 15 mins hair apposition 2 vs 4 out of 10 pain score At 7 days 100% of the hair apposition group had adequate wound healing compared to 96% of the suture group.  At 4 weeks all wounds were healed, but scars were bigger in the suture group When asked if they would want the same procedure in the future, 84% of the hair apposition group said "yes" compared to 10% of the suture group It is unknown whether hair apposition technique has any advantage over simply applying skin glue to a scalp laceration. Wound closure strips for skin lacerations 2021 systematic review comparing wound closure strips ("steri-strips") to sutures and to skin glue included traumatic wounds in ED and patients in the operating room all studies were small, at high risk of bias infection and dehiscence equivalent in all three groups wound closure strips associated with better cosmesis in 1 small unblinded RCT wound closure strips generally faster and less painful compared to sutures Surgical skin staples for skin lacerations 2020 meta-analysis of 42 low quality RCTs of operating room studies staples are generally faster than sutures cost is about equivalent no differences in cosmesis the overall adverse event rate is about double with staples Absorbable vs non-absorbable sutures for skin lacerations 2007 meta-analysis of 7 small unblinded underpowered ED or operating room RCTs comparing absorbable to absorbable sutures for skin lacerations no overall statistical difference in cosmesis Odds Ratio (OR) for dehiscence 0.16 favouring absorbable sutures