Tools for Practice Outils pour la pratique

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?

Punch biopsies 4mm do not require closure but 8mm do.  Skin-glue is similar to tape or sutures for simple wounds for clinician-rated cosmesis and patient satisfaction with similar infection rates of 4-7%.  However, dehiscence occurs in ~5% with skin-glue compared to 1% with suture. Absorbable sutures have similar outcomes to non-absorbable sutures.

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

  • Results statistically significant unless otherwise stated.
  • Punch biopsy: One randomized controlled trial (RCT), 77 patients, two 4- or 8-mm punch biopsies on arm/leg/trunk, one sutured and other closed by secondary-intention. Assessed at 9 months.1
    • Clinician-rated comesis: No difference.
    • Patient preference:
      • 4mm: No difference.
      • 8mm: 14% preferred secondary-intention versus 53% preferred suture (remainder: no preference).
  • Skin-glue (adhesive) versus sutures: One systematic review (33 RCTs, 2793 lacerations) of incisional wounds:2
    • Wound dehiscence (17 RCTs, 1225 patients): 4.5% skin-glue versus 1.3% sutures
    • Time to closure (5 RCTs, 407 patients): Not pooled, results inconsistent.
    • Clinician/patient satisfaction, infection: No difference.
    • Second systematic review3 included non-randomized studies: No difference in wound cosmesis.
  • Skin-glue versus tape: Two systematic reviews (16-33 RCTs, 2793-9783 lacerations), children/adults with lacerations/incisions:2,3
    • Clinician-rated cosmesis (3 RCTs, 173 wounds):3 Standard mean difference reported, not clinically interpretable.
      • RCT4 (86 patients) with similar results, 2-month wound cosmesis [100-point visual analogue scale (VAS), higher=better]: 56 skin-glue versus 63 tape (difference not likely clinically meaningful).5
    • Patient satisfaction, dehiscence, infection, or time-to-perform-closure:3 No difference.
  • Skin-glue versus tape/staples/sutures combined: One systematic review (13 RCTs, 1322 lacerations),6 adult/children lacerations:
    • Pain VAS (100-point, lower=better) (1 RCT, 136 patients): 11 points lower with skin-glue.
    • Time to perform closure (6 RCTs, 584 patients): Skin-glue 4.7 minutes faster.
    • Cosmetic appearance, dehiscence, infection: No difference.
  • Absorbable versus non-absorbable sutures: Two systematic reviews (7-11 RCTs, 702-751 patients), children/adults with lacerations/incisions:7,8
    • Cosmesis, patient satisfaction, dehiscence: No difference.7,8
  • Adverse events:3 No difference in infection (4-7.6%).
  • Limitations: Differing rating scales/outcomes, blinding of assessors unclear/unknown.3,4

  • Simple lacerations can be cleaned with tap water9 and repaired with clean non-sterile gloves without increased infection.10
  • Skin-glue: Octylcyanoacrylate (DermabondTM) or butylcyanoacrylate (KrazyglueTM).

Augustine Opara May 31, 2024


Bruce Zimmermann June 7, 2024

Sutures are seem better if larger punch biopsies

Latest Tools for Practice
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • Jennifer Young MD CCFP-EM
  • Jennifer Potter MD CCFP

1. Christenson L, Phillips P, Weaver A, et al. Arch Dermatol. 2005 Sep; 141(9):1093-9.

2. Dumville J, Coulthard P, Worthington H et al. Cochrane Database Syst Rev. 2014 Nov 28; 2014(11):CD004287.

3. Tandon S, Smale M, Pacilli M, et al. J Pediatr Surg. 2021 May; 56(5):1020-1029.

4. Zempsky W, Parrotti D, Grem C et al. Pediatr Emerg Care. 2004 Aug; 20(8):519-24.

5. Quinn J, Drzewiecki A, Stiell I et al. Am J Emerg Med. 1995 Mar; 13(2):229-31.

6. Farion K, Osmond M, Hartling L et al. Cochrane Database Syst Rev. 2002; 2002(3):CD003326.

7. Gillanders S, Anderson S, Mellon L et al. J Plast Reconstr Aesthet Surg. 2018 Dec; 71(12):1682-1692.

8. Al-Abdullah T, Plint A, Fergusson D. Pediatr Emerg Care. 2007 May; 23(5):339-44.

9. Allan, M. Lacerations: Sterile Gloves and Water? Tools for Practice #2. Accessible at Accessed May 3, 2024.

10. Steve E, Allan M. All You Need is Glove: Are non-sterile gloves safe for excisions in the office? Tools for Practice #178. Accessible at Accessed May 3, 2024.

Authors do not have any conflicts of interest to declare.