Laceration Thin SkinLacerations of elderly patients or chronic corticosteroid users can be a challenge because they often have very thin skin. Sutures can tear through the fragile skin. Tissue adhesives may not adequately close the typically irregularly-edged laceration.

How do you repair these lacerations?
Do you just slap a band-aid on it?

Trick of the Trade

Use a steristrip-suture combination approach.

Apply steristrips to reapproximate the wound edges. Reinforce the steristrips with suture material, as demonstrated in the article’s figure. The steristrips provide an artificial layer of “skin”, which sutures can use to reapproximate the wound edges.

 SteriSutureFig1

My commentary

While I haven’t used the approach described in this article, I have, however, used steristrips positioned in parallel with the wound edge (rather than perpendicularly). Borrowing from the article’s figure, I drew in the longitudinally-positioned steristrips to show how I’ve done it in the past. It works great. I don’t use the perpendicular steristrips. I find that longitudinal steristrips provide even tensile strength along the wound edges.

 SteriSuture_Revised

Reference
Davis M, Nakhdjevani A, Lidder S. Suture/Steri-strip combination for the management of lacerations in thin-skinned individuals. J Emerg Med, 2011. 40(3), 322-3. PMID: 20880653.

 

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg San Francisco General. Founder of ALiEM @aliemteam #PostitPearls https://t.co/7v7cgJqNEn
Michelle Lin, MD