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 14, 2025

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