I get not wanting to have sutures. It takes time, it can hurt, you have to remove the sutures later. Particularly in a kid, it seems like a dream to just glue it shut.
What have studies shown?
- There is a newer-generation cyanoacrylate that improves on the butylcyanoacrylates currently in use
- It is a pliable, waterproof, film adhesive that can be applied to a laceration
- It lasts 7 to 14 days.
- It is not seen as a replacement for sutures
- When use it? under casts; simple lacerations in kids, or where you cannot do follow up visits.
- When to avoid? highly moving areas like joints, for areas with usage and friction like hands or feet; or for areas where exact alignment is a priority, such as the face or eyelids.
Other studies have shown better initial happiness: less pain, good recovery. BUT it shows a higher rate of dehisence. What does that mean? Down the road the incision separates, indents, or opens up.
What do I think?
I am a surgeon, so I love to sew. It is predictable, easy, and has good long term results. It is easy for me to say “just put a stitch in it” because I can do it.
I heard someone say once that skin glue (dermabond) is equivalent to a 6.0 suture. For you non surgery geeks out there, a 6.0 is a whimpy suture. It is fine, gives little strength, and is used in my practice primarily for eyelid surgery. For the rest of the face I use 5.0 or stronger. For the body I use 4.0. If you use a weak suture, then it won’t hold the tissue long enough for it to heal well. This explains why skin glue isn’t good for high motion areas. It explains why there are long term issues with the wound opening up or forming a bad scar.
If you can see any tissue below the top layer of the skin, like fat or muscle, those lacerations require deep sutures to align the deeper tissue layers and take tension off the skin closure. This gives a more stable wound and a prettier scar. These need to be sewn.
If your laceration wants to gape open or separate, it likely needs deeper layered sutures and a stronger closure.
For the issue of having to remove the sutures later, we can use dissolving sutures, which we never remove- your body breaks them down internally.
SO. I almost never use or recommend tissue glue. I think there are almost no indications where it is better than sutures. The wounds that look “okay to glue” are likely ones that are in the superficial layer of the skin only. If sutures are not an option, I get it. But otherwise stitch it up.