Superficial skin lesions confined to the cutis can be closed with the aid of Steri-Strips, wound adhesive strips, or tissue adhesive. Wounds that extend deeper than the cutis are closed with atraumatic disposable suture material.
Suture Thread
Suture thread can be made of reabsorbable or non-reabsorbable material. Both categories contain monofilament and multifilament (braided) threads. They are available in various thicknesses. The diameter is reported with zeroes, whereby thinner thread corresponds with a higher number of zeroes: 6 – 5 – 4 – 3 – 2 – 1 – 0 – 00 – 000 – 0000 – 00000 – 000000.
In practice, 3/0 or 4/0 monofilament suture thread is used for simple suturing (5/0 is sometimes used for the face). A 3/0 reabsorbable thread is used subcutaneously.
When selecting a suture thread, the following aspects should be considered:
- Tensile strength. This refers to the degree of stress a thread can be subjected to before it breaks.
- Knot security. This is greatest when the thread is elastic, non-smooth, and contains multiple filaments (fibres).
- Tissue reaction. The risk of tissue reactions is greater with reabsorbable thread than synthetic, non-reabsorbable thread.
- Capillary action. Compared with monofilament thread, multifilament thread has a greater capacity for taking up fluid. Tissue fluid can penetrate between the filaments, forming a nutrient medium for bacteria. This capillary action can be reduced by encasing the multifilament thread (nylon) with impermeable material (silicone or wax). Multifilament thread should not be used for heavily contaminated wounds.
- Allergic reactions. These can arise when reabsorbable material is used.
Wound Adhesive Strips
Correct application of Steri-Strips to incised wounds that run parallel to skin lines (without tension and not running over joints), yields excellent cosmetic results that are entirely comparable to those achieved with tissue adhesive [Figure 2].
Figure 2
Tissue Adhesive
Tissue adhesive is an autopolymerising adhesive that polymerises within a few seconds. Tissue adhesive is applied only to superficial wounds confined to the cutis without tension. The edges of the wound must be dry.
Tissue adhesive has the following advantages over suturing with needle and thread:
- The result is more attractive (there is no scarring from suture thread).
- Adhesive saves time.
- Infiltration anaesthesia is unnecessary.
- Suture removal is avoided.
- It is less traumatic for paediatric patients.
- Since applying adhesive is a painless procedure, patients will maintain their trust in the general practitioner.
The disadvantages are:
- Tissue toxicity – the adhesive can damage the eyes and blood vessels.
- Improper use with deep wounds can create dead spaces (no adaptation of deep-lying tissues), whereby infection can occur.
Tissue adhesive should only be used for the following (see also “Skills“):
- Small wounds confined to the cutis.
- Small wounds that run parallel to skin lines.
- Non-contusional small wounds.
- Small wounds without tension.