Introduction
Surgeons face constant pressure to balance closure speed, cosmetic outcomes, and patient comfort—all while managing procedure costs and follow-up care requirements. The choice between adhesive strips, sutures, staples, or bioabsorbable closure systems directly impacts healing time, scarring, infection risk, and the need for removal appointments.
According to market research, the global wound closure strips market reached $260.3 million in 2025, reflecting their widespread adoption in minor wound management. Clinical studies demonstrate that for appropriate low-tension wounds, adhesive strips deliver infection rates and cosmetic outcomes comparable to traditional sutures.
This guide examines when adhesive strips are the right choice, proper application techniques, and critical contraindications—alongside modern alternatives like bioabsorbable stapler systems that offer the speed of traditional staplers without compromising cosmetic results.
TL;DR
- Sterile, porous tape strips close superficial wounds without piercing skin
- Selection depends on wound tension, location, skin condition, moisture exposure, and healing timeline
- Proper application requires clean/dry skin, perpendicular placement, and adequate strip overlap
- Avoid high-tension wounds, infected sites, fragile skin, and deep closures
- Consider sutures, staples, tissue adhesives, or bioabsorbable systems like SubQ It! for alternative closure
What Are Adhesive Skin Closure Strips?
Adhesive skin closure strips are sterile, porous surgical tape strips applied across lacerations to approximate wound edges without penetrating the skin. Also known by the genericized trademark "Steri-Strips" (3M's brand name), these devices are external wound closures.
The FDA classifies these as Class II medical devices under regulation 21 CFR 880.5240 with product code KGX.
Types and Variations
Reinforced Skin Closures — Polyester-reinforced strips provide increased tensile strength for wounds requiring additional support, particularly in areas prone to movement.
Blend Tone Closures — Beige-colored strips designed for cosmetic applications on visible areas like the face, arms, and hands.
Waterproof Variants — Synthetic material strips offer moisture resistance for patients who need to bathe or for wounds in moisture-prone areas.
Butterfly Closures — Connected two-pad variations designed for specific wound geometries and contoured surfaces.
Understanding these variations helps contextualize the engineering behind their design.
Core Components
The engineering behind adhesive strips includes three essential elements:
| Component | Material | Function |
|---|---|---|
| Porous backing | Non-woven rayon | Allows air circulation and moisture vapor transmission, preventing skin maceration |
| Hypoallergenic adhesive | Pressure-sensitive acrylate | Bonds firmly to skin without significant irritation |
| Reinforcement filaments | Polyester (optional) | Increases tensile strength and prevents stretching under load |
Key Benefits
Adhesive strips offer several clinical advantages:
- No skin penetration, reducing infection risk
- Minimal scarring compared to sutures and staples
- No removal appointment needed
- Easy application without specialized training
- Lower cost than suturing procedures
Research demonstrates no significant difference in infection rates between adhesive strips and sutures for appropriate wound types. In pediatric facial lacerations and low-tension surgical wounds, strips have shown cosmetic results statistically equivalent to sutures and tissue adhesives.
For surgical incisions requiring faster closure with superior cosmetic outcomes, bioabsorbable subcuticular closure systems like SubQ It! offer an alternative that combines speed with minimal scarring while eliminating the need for removal.
How to Choose the Right Adhesive Skin Closure Strips
Selecting appropriate closure strips requires evaluating wound characteristics, anatomical location, patient factors, and expected healing conditions.
Matching strip specifications to clinical requirements ensures optimal wound closure and healing outcomes.
Wound Characteristics and Tension Level
Strips excel for facial lacerations, surgical incisions with underlying sutures, and wounds that can be easily brought together with fingers. These are low-tension wounds ideal for strip closure.
High-tension areas where significant retraction forces exist should not be closed with strips alone.
Wounds requiring more than 5N (approximately 1.1 pounds) of force to bring edges together should not be closed with strips alone. Application under tension causes traction blisters and skin shearing.
Superficial wounds are ideal candidates for strip closure. Deep lacerations requiring subcuticular layer closure need sutures or alternative closure methods, with strips used only as superficial adjuncts.
Anatomical Location and Contour
Different body locations present unique challenges for strip adhesion and wound closure success.
Ideal locations:
- Face and scalp (low tension, cosmetically sensitive)
- Areas with irregular contours where rigid closures may fail
- Surgical incisions with underlying deep sutures
Challenging locations:
- High-mobility joints (consider elastic variants)
- Areas with thick skin requiring more robust closure
- Hairy regions where adhesion may be compromised
Patient Skin Condition
Elderly patients, those on long-term corticosteroids, or individuals with compromised skin integrity face higher risk of Medical Adhesive-Related Skin Injury (MARSI), including skin tears upon removal.
Assessment factors:
- Skin hydration and elasticity
- Presence of dermatological conditions
- History of adhesive sensitivities
- Nutritional status affecting wound healing
Strips are not suitable where exudate, skin oils, or moisture prevent adequate adhesion. Thoroughly dry skin before application.
Environmental and Activity Exposure
Beyond patient factors, consider the environment and activities the closure must withstand.
Waterproof selection: Choose waterproof variants for patients needing to shower or for wounds in naturally moist areas. Some systems include transparent, waterproof dressings that provide viral and bacterial barriers.
Activity restrictions: Patient lifestyle matters. Athletes and manual laborers may require reinforced strips or alternative closure methods to withstand increased mechanical stress.
Strip Size and Reinforcement Needs
Strips should extend 3-4cm beyond wound edges on both sides, with width selected based on wound depth and required holding strength. Space strips 2-3mm apart for optimal drainage.
Reinforcement decisions:
- Use reinforced strips for facial lacerations requiring cosmetic precision
- Standard non-reinforced or elastic variants work better for contoured sites or areas with potential edema
Cosmetic Considerations
For visible areas where appearance is paramount, blend-tone strips minimize visual impact during healing. While strips generally produce less scarring than sutures, proper selection and technique further optimize aesthetic outcomes. Studies show strips may produce less visible scarring in small wounds (<20mm) compared to sutures.
Step-by-Step Application Technique for Adhesive Skin Closure Strips
Correct application technique ensures secure wound closure and optimal healing. Following this protocol maximizes strip effectiveness and prevents complications.
Pre-Application Preparation
Clean the wound thoroughly:
- Irrigate with sterile saline to remove debris
- Achieve complete hemostasis before strip application
- Thoroughly dry skin around the wound using sterile gauze
- Optionally apply skin adhesive to surrounding skin (not wound edges) to enhance adhesion
Position the patient to minimize tension across the wound during application. The wound edges should approximate easily without pulling.
Once preparation is complete, you're ready to place the strips using the technique below.
Strip Placement Technique
Apply strips in this sequence:
- Start at wound center: Place the first strip at the midpoint to align edges properly
- Work outward: Apply subsequent strips by bisecting remaining spaces
- Maintain spacing: Space strips approximately 2-3mm apart to allow exudate drainage
- Ensure extension: Each strip should extend 3-4cm beyond wound edges on both sides
While applying each strip:
- Gently push wound edges together
- Avoid over-tightening, which causes tissue strangulation
- Apply strips without tension—they hold edges together, not pull them together
For irregular wounds, cut strips to appropriate lengths and layer for added security if needed.
Securing and Finishing
Apply parallel strips along the wound length approximately 12mm from the ends of primary strips. This "railroad track" technique distributes tension and reduces shear force at strip ends.
Inspect the closure to verify:
- All wound edges meet properly
- No gaps exist between strips
- Strips are firmly adhered without skin puckering
Post-Application Care Instructions
Provide these instructions to patients:
- Keep strips dry for 24-48 hours initially
- Avoid tension or stretching across the wound
- Gently pat dry if strips get wet
- Typical wear time: 5-14 days depending on location and healing rate
- Strips naturally loosen and fall off as healing progresses
When removal is necessary, pull strips "low and slow" toward the wound edge, supporting the skin to prevent reopening or tearing.
Monitor for these complications:
- Strip loosening before 5 days
- Wound reopening or gap formation
- Signs of infection (redness, warmth, discharge, increased pain)
When NOT to Use Adhesive Skin Closure Strips
While adhesive strips are versatile, certain wound and patient characteristics make them inappropriate or ineffective. Understanding contraindications prevents closure failure and complications.
High-Tension Wounds and Deep Lacerations
Adhesive strips cannot support wounds requiring deep layer approximation:
- Wounds under significant tension that cannot be easily approximated with fingers
- Deep lacerations requiring subcuticular layer approximation
- Wounds over joints without deep supporting sutures
- Scalp wounds with separated galea
- Wounds with undermining
The adhesive bond is insufficient to maintain closure against significant retraction forces. Dehiscence rates are significantly higher than with sutures or staples in these scenarios.
Infected or Contaminated Wounds
Infection is an absolute contraindication. Closing contaminated wounds traps bacteria and exacerbates infection risk.
Never apply strips to:
- Actively infected wounds
- Heavily contaminated injuries (animal bites, grossly dirty wounds)
- Wounds with active drainage preventing adhesion
- Wounds requiring thorough debridement before closure
Compromised Skin Conditions
Certain patient conditions compromise skin integrity and prevent effective adhesion:
- Extremely fragile skin (advanced age, chronic steroid use)
- Active dermatitis or skin disease at wound site
- Radiation-damaged skin
- Dehydration or malnutrition affecting skin integrity
Poor adhesion leads to closure failure. Approximately 10.4% of cases experience blistering, often linked to fragile skin or improper technique. For wounds requiring deeper closure or involving compromised skin, alternative methods like subcuticular sutures or bioabsorbable closure systems may provide more reliable outcomes.
Adhesive Strips vs. Alternative Closure Methods
Wound closure method selection depends on wound characteristics, required strength, cosmetic goals, and procedural context. Understanding the strengths and limitations of each method enables optimal clinical decision-making.
Adhesive Strips vs. Sutures
| Feature | Adhesive Strips | Sutures |
|---|---|---|
| Application time | Fast (seconds per strip) | Slow (42 seconds per stitch) |
| Skill requirement | Minimal training | Extensive training needed |
| Scarring | Less visible scarring | Risk of "railroad track" marks |
| Tensile strength | Low (surface only) | High (deep tissue support) |
| Pain | Painless application | Requires local anesthesia |
| Cost | Low ($2-$4 range) | Moderate to high (includes removal) |
Clinical scenarios vary by wound characteristics:
- Choose strips: Low-tension facial lacerations, superficial wounds, pediatric patients
- Choose sutures: High-tension wounds, deep lacerations, areas requiring subcuticular support
Adhesive Strips vs. Surgical Staples
Staples close long incisions fastest (7 seconds per staple), while strips offer slightly slower but still rapid application compared to sutures.
However, staples require removal appointments and cause patient discomfort, whereas strips self-detach naturally. The cosmetic difference is significant: strips produce finer scars without the "train track" appearance characteristic of staples. Patient comfort also favors strips throughout the healing process, eliminating anxiety-inducing removal procedures.
Adhesive Strips vs. Tissue Adhesives
Tissue adhesives like 2-octyl cyanoacrylate (Dermabond) form waterproof barriers, while strips allow air circulation. Each has distinct advantages:
Tissue adhesives apply 30% faster than strips in some contexts and create waterproof barriers, but carry higher per-unit costs and risk dehiscence under tension.
For enhanced closure security, strips and adhesives work well together—particularly in pediatric applications where minimizing trauma matters most.
Subcuticular Closure Systems as an Alternative
For surgical incisions requiring both subcuticular support and optimal cosmetic outcomes, bioabsorbable subcuticular closure systems like SubQ It! offer distinct advantages.
These systems place fasteners beneath the skin surface for internal wound approximation without external piercing. Key features include:
- Closures average 7X faster than manual sutures (7 seconds vs. 42 seconds per closure point)
- Eliminates "train track" scarring by never piercing external skin
- Bioabsorbable PLGA fasteners maintain 80% strength for 21 days before natural absorption
- FDA-cleared for abdominal, thoracic, gynecologic, orthopedic, plastic and reconstructive surgery
SubQ It! combines the speed advantages of stapling with superior aesthetic results and patient comfort, making it suitable for surgical incisions where both efficiency and cosmetic outcomes matter. The system is available in SU-10 (for incisions up to 10cm) and SU-25 (for incisions up to 25cm) configurations.
Conclusion
Selecting the appropriate wound closure method requires evaluating wound characteristics, patient factors, and healing goals rather than defaulting to the most familiar option. Adhesive skin closure strips excel in specific scenarios—low-tension wounds, cosmetically sensitive areas, and patients requiring easy care—but have clear limitations that require alternative methods for complex wounds.
This evaluation reveals where strips work best. For superficial lacerations with minimal tension, they offer an ideal combination of simplicity, low cost, and excellent cosmetic outcomes. High-tension wounds, deep lacerations, and compromised skin conditions require more robust methods like sutures or bioabsorbable subcuticular systems.
Wound closure technique continues to evolve with innovations in bioabsorbable materials and closure systems. Modern subcuticular systems like SubQ It! combine stapler-like speed with superior cosmetic outcomes, offering surgeons alternatives to traditional strips and sutures for appropriate surgical incisions.
Staying informed about these options—whether adhesive strips for minor lacerations or bioabsorbable fastener systems for surgical closures—improves patient outcomes and procedural efficiency.
Frequently Asked Questions
What is adhesive skin closure?
Adhesive skin closure uses sterile surgical tape strips to hold wound edges together without penetrating the skin. These FDA Class II medical devices serve as a non-invasive alternative to sutures for low-tension wounds, offering comparable healing with reduced infection risk.
How long do skin closure strips stay on?
Strips typically remain in place for 5-14 days depending on wound location and activity level. They naturally loosen and fall off as the wound heals, or can be gently removed after 7-10 days if still adherent.
What is the best wound closure?
The best closure method depends on wound depth, tension, and location. Adhesive strips work for superficial low-tension wounds, sutures for deep or high-tension wounds, and tissue adhesives for small pediatric lacerations.
What glue do doctors use to close wounds?
Doctors use medical-grade cyanoacrylate adhesives like Dermabond and Histoacryl. These FDA-approved topical skin adhesives provide waterproof barriers and antimicrobial properties for appropriate wound types.
What suture is used for skin closure?
Non-absorbable sutures like nylon and polypropylene require removal after healing. Absorbable sutures like Vicryl and Monocryl dissolve over time and don't require removal, making them ideal for subcuticular closure.
