Introduction
A 7-year-old child arrives at the emergency department with a 3 cm forehead laceration from a playground fall. The wound is clean and linear, but the child is terrified of needles.
The physician faces a critical decision: traditional sutures would provide strong closure but require painful injections and traumatize an already frightened patient. Instead, the clinician opts for reinforced skin closure strips—a non-invasive approach that approximates wound edges effectively while avoiding the distress of suturing.
Reinforced skin closure strips, commonly known by the 3M brand name Steri-Strip, offer a valuable alternative to sutures and staples for appropriate wounds.
These sterile adhesive strips provide effective wound closure for superficial, low-tension lacerations while eliminating needle punctures, reducing infection risk, and often producing superior cosmetic outcomes.
TLDR
- Reinforced strips work best for superficial, low-tension lacerations under 5cm with minimal depth
- Proper application requires dry skin, correct spacing (3mm apart), and avoiding excessive tension
- 2016 clinical study shows equivalent infection and cosmetic outcomes to sutures for appropriate wounds
- Strips offer 7X cost savings and faster application than sutures, with no removal needed
- Alternatives include tissue adhesives, traditional sutures, and subcutaneous closure systems like SubQ It!
What Are Reinforced Skin Closure Strips?
Definition and Composition
Reinforced skin closure strips are sterile adhesive devices constructed from porous, non-woven backing material—typically a blend of rayon and polyester—coated with hypoallergenic, pressure-sensitive acrylate adhesive.
The defining feature is the integration of polyester filaments running through the backing material, providing significantly greater tensile strength than standard surgical tape.
"Steri-Strip" is a registered trademark of 3M Company that has become a genericized term for any reinforced wound closure strip, similar to how "Kleenex" refers to facial tissues.
Competitor products include:
- Leukostrip (Smith+Nephew)
- Curi-Strip (Cardinal Health)
Each offers similar functionality with slight variations in materials and adhesive formulations.
The strips work through surface adhesion rather than penetrating tissue. When applied with firm pressure, the adhesive bonds to the skin surface, holding wound edges together while the underlying tissue heals.
Types of Wounds Suitable for Strip Closure
Understanding which wounds benefit from strip closure helps determine when this method is appropriate versus other closure techniques.
Ideal wound profiles:
- Clean, linear lacerations with minimal tension
- Typically less than 5cm in length and less than 0.5cm in depth
- Superficial wounds involving only the epidermis and superficial dermis
- Wounds where edges can be easily approximated with gentle finger pressure
Contraindications:
- Infected or contaminated wounds
- High-tension areas where muscle movement creates significant pulling forces
- Deep lacerations requiring multi-layer closure
- Wounds with significant gaping that cannot be approximated without deep sutures
- Areas with excessive moisture, hair, or skin oils that prevent adhesion
When to Use Reinforced Skin Closure Strips
Clinical Indications
Reinforced strips serve as primary closure for superficial lacerations and as adjunctive support following suture or staple removal. Randomized controlled trials show that strips produce infection and dehiscence rates comparable to sutures for appropriate low-tension wounds, with no statistically significant difference in long-term cosmetic outcomes.
Primary clinical uses include:
- Superficial facial lacerations in cooperative patients
- Surgical incision reinforcement after early suture/staple removal (typically day 5-7)
- Pediatric patients where "no-needle" closure reduces procedural anxiety and pain
- Elderly patients with fragile skin prone to tearing from suture tension
Anatomical Considerations
Ideal anatomical locations:
- Forehead and chin (relatively flat surfaces with minimal tension)
- Chest and abdomen (in areas away from high-movement zones)
- Extremities with minimal joint involvement
- Areas prone to swelling where sutures might cause tissue strangulation
Their flexibility allows them to conform well to contoured body areas. The porous backing permits moisture vapor transmission, reducing maceration risk compared to occlusive dressings.
However, certain anatomical sites compromise adhesion:
Areas to avoid:
- Scalp (hair interferes with adhesion)
- Hands and feet (high moisture from sweat glands)
- High-tension joints in flexion (knees, elbows)
- Axillae and groin (moisture and movement compromise adhesion)
Patient Selection Factors
Successful outcomes depend heavily on patient factors. Cooperative patients who understand care instructions achieve the best results. These closures are particularly valuable for children, as studies show parents view strips as equally acceptable to tissue adhesives while avoiding injection pain.
For elderly patients with fragile, thin skin, strips offer gentler closure than sutures but require caution during removal to prevent skin stripping and Medical Adhesive-Related Skin Injury (MARSI).
When Strips Complement Other Closure Methods
These closures frequently serve as adjuncts to deep dermal sutures, providing additional wound edge approximation after buried sutures relieve tension.
They're commonly applied after suture or staple removal (typically 5-7 days post-procedure) to prevent wound dehiscence during early healing when tissue strength is still developing.
While this practice is common in clinical settings, evidence suggests limitations to this approach. One randomized trial found that adding adhesive strips to buried dermal sutures did not significantly improve cosmetic outcomes or reduce scar width compared to dermal sutures alone, suggesting their primary value in this context is mechanical wound edge security rather than cosmetic enhancement.
Step-by-Step Application Technique
Wound Preparation
Proper preparation is critical for strip adhesion and success:
- Clean thoroughly: Irrigate the wound with saline to remove debris and contaminants. Clean at least 6.4 cm (2.5 inches) around the wound.
- Achieve complete hemostasis: Any bleeding or moisture will prevent adhesion. Apply pressure until bleeding stops completely.
- Dry the skin: Pat the skin completely dry. Strips will not adhere to moist surfaces.
- Remove oils: Use alcohol wipes or soap to remove natural skin oils that interfere with adhesion.
Optional: Compound Benzoin Tincture (CBT)
For enhanced adhesion, particularly in challenging locations or for patients with oily skin, apply a thin film of Compound Benzoin Tincture to the skin on each side of the wound—avoiding the wound edge itself.
Allow it to dry until tacky (approximately 30-45 seconds) before applying strips.
Caution: CBT can cause allergic contact dermatitis. Do not use in patients with known sensitivity to benzoin compounds.
Strip Selection and Sizing
Choose strip width based on wound characteristics:
- 1/4 inch (6mm): Small facial lacerations
- 1/2 inch (12mm): Most general-purpose applications
- 1 inch (25mm): Longer wounds requiring broader support
Sizing guidelines:
- Strips should extend 1.5-2 inches (4-5 cm) beyond wound edges on each side
- Space strips approximately 3mm (1/8 inch) apart during application
Proper Application Method
Once preparation is complete, follow these steps for optimal closure:
- Start at wound center: Place the first strip at the wound's midpoint
- Apply one end first: Secure one half firmly to one side
- Approximate edges: Bring wound edges together with your other hand
- Apply gentle tension: Stretch slightly while securing the other end—avoid excessive force
- Press firmly: Activate the adhesive across the entire strip
- Continue outward: Place additional strips 3mm apart from center
Critical warning: Do not apply strips under tension (strapping), as this causes blistering and skin necrosis. Strips should hold edges together, not pull them together.
Securing and Reinforcing
After placing parallel strips across the wound, consider applying perpendicular "stay strips" at wound ends.
These anchor the parallel strips and prevent edge lifting, distributing shear forces more evenly.
Post-Application Assessment
Verify proper application by checking:
- Wound edges are closely opposed without gaping or overlapping
- Strips lie flat without puckering
- Edges are level and approximated
- No excessive tension causing skin blanching around the strips
- Spacing allows for wound drainage
Patient Instructions and Care Guidelines
First 24-48 hours:
- Keep strips completely dry
- Avoid activities causing sweating or wound tension
- Leave strips undisturbed
After 48 hours:
- Gentle cleansing around strips is acceptable
- Pat dry carefully after washing
- Avoid soaking (no swimming or prolonged bathing)
Duration:
- Most wounds: 5-7 days
- Surgical incisions: 10-14 days
- Remove earlier if infection signs appear (redness, swelling, drainage)
Removal technique:Soak with water, then gently peel parallel to skin surface. Never pull perpendicular to skin.
Benefits and Limitations of Reinforced Skin Closure Strips
Reinforced skin closure strips offer distinct advantages in appropriate clinical scenarios, but understanding their limitations is essential for optimal wound management.
Clinical Advantages
Reinforced strips offer several evidence-based benefits:
Lower infection risk: Strips do not puncture through the skin, eliminating the pathway for bacterial entry that sutures and staples create. Research shows infection rates of approximately 1% or less in clean wounds, matching suture outcomes.
Superior cosmetic outcomes: Strips avoid the "train track" scarring pattern that sutures and staples can leave. Long-term cosmetic outcome scores (POSAS, VAS) show no significant difference between strips and sutures for appropriate wounds.
Reduced pain: Application is painless compared to suture placement requiring local anesthesia. Removal is also significantly less painful than suture or staple removal.
Time and cost efficiency: Strip application takes significantly less time than suturing—in some comparisons, 1.48 seconds versus 8.8 minutes.
Material costs are substantially lower, and no removal appointment is needed.
While strips excel in these areas, they're not suitable for every wound type.
Limitations and Disadvantages
Key limitations include:
- Lack tensile strength for high-tension wounds—dehiscence rates increase when used inappropriately in high-stress areas
- Fail prematurely in sweaty, oily, or high-moisture environments where patients cannot keep wounds dry
- Cannot achieve hemostasis (only work after bleeding is controlled through other means)
- Limited to superficial wounds—cannot close deep tissue layers or provide multi-layer closure for complex wounds
Types and Variations of Reinforced Skin Closure Strips
Standard Reinforced Strips (3M Steri-Strip)
The standard reinforced Steri-Strip features white rayon/polyester backing with polyester filament reinforcement. These strips provide increased tensile strength compared to non-reinforced paper surgical tape while maintaining breathability through the microporous backing.
Common sizes include:
- 1/8 inch x 3 inch (3mm x 75mm)
- 1/4 inch x 3 inch (6mm x 75mm)
- 1/2 inch x 4 inch (12mm x 100mm)
Specialized Variations
Beyond the standard reinforced strips, 3M offers several specialized variations designed for specific clinical scenarios.
3M Steri-Strip Product Family:
| Type | Features | Best For |
|---|---|---|
| Reinforced (R Series) | Polyester filaments, maximum strength | General lacerations, surgical incisions |
| Elastic (E Series) | Flexible backing, non-reinforced | Contoured areas, joints with movement |
| Blend Tone (B Series) | Skin-colored, non-reinforced | Face, hands, visible cosmetic areas |
| Antimicrobial (A Series) | Iodophor-containing adhesive | High infection-risk wounds |
| Wound Closure System | Strips + Tegaderm film overlay | Extended wear, waterproof protection |
Several manufacturers offer alternatives to 3M's Steri-Strip line:
Competitor variations:
- Leukostrip (Smith+Nephew): 100% polyamide material, elastic with hypoallergenic adhesive, offers superior moisture permeability
- Curi-Strip (Medline/Cardinal): Cost-effective alternative with similar reinforced construction
Alternatives to Reinforced Skin Closure Strips
Traditional Closure Methods
| Method | Ideal Use Cases | Advantages | Disadvantages |
|---|---|---|---|
| Sutures | Deep wounds, high-tension areas, complex geometry | Highest tensile strength, precise approximation, can ligate vessels | Painful, requires removal, higher cost, needle-stick risk |
| Surgical Staples | Scalp, trunk, extremities (linear lacerations) | Very fast application | Higher pain on removal, poor cosmesis, requires removal |
| Adhesive Strips | Superficial, low-tension wounds <5cm | Painless, low infection risk, no removal needed, excellent cosmesis | Limited tensile strength, adhesion failures in moisture |
Tissue Adhesives (Surgical Glue)
Cyanoacrylate-based adhesives (Dermabond, LiquiBand) polymerize on contact with moisture, forming a flexible film that holds wound edges together.
They work best for low-tension, linear wounds on the face and other non-mucosal areas.
Advantages: Fast application, waterproof, antimicrobial barrier, no removal needed
Disadvantages: Approximately 2% higher dehiscence rate than sutures, higher cost than strips
Combination approach: Combining strips with tissue adhesive doubles tensile strength compared to either method alone, but it increases cost and procedure time.
Subcutaneous Closure Systems
Traditional subcuticular sutures close the dermal layer beneath the skin surface, relieving tension on the epidermis and avoiding visible suture marks.
These require manual suturing skill and time.
Modern subcutaneous closure devices offer an alternative approach. SubQ It! Bioabsorbable Skin Closure System is a disposable stapler pre-loaded with bioabsorbable fasteners inserted subcutaneously using retractable surgical needles.
Unlike surface strips or traditional metal staples, the external skin is never pierced—fasteners engage tissue beneath the skin surface through a barbed design connected by a flexible bridge.
Key advantages of subcutaneous systems like SubQ It!:
- Combines stapler speed (7 seconds per fastener) with superior cosmetic outcomes
- Eliminates "train track" scarring from surface closures
- No removal procedures needed (fasteners are absorbed by the body)
- Maintains 80% strength for 21 days during critical healing
- FDA-cleared for abdominal, thoracic, gynecologic, orthopedic, plastic and reconstructive surgery
SubQ It! is particularly valuable for surgical incisions—including laparoscopic trocar sites—where both speed and optimal cosmetic outcomes are priorities. The system comes in two configurations: SU-10 (10 fasteners for incisions up to 10cm) and SU-25 (25 fasteners for incisions up to 25cm).
Choosing the Right Closure Method
Clinical decision framework:
Step 1 - Assess wound tension:
- High tension/over joints → Sutures or staples required
- Low tension → Proceed to Step 2
Step 2 - Assess wound depth:
- Deep (involves dermis/subcutaneous tissue) → Deep sutures first, then evaluate surface closure
- Superficial → Proceed to Step 3
Step 3 - Select surface closure:
- Pediatric/anxious patients → Adhesive strips or tissue adhesive
- Fragile elderly skin → Gentle strips with caution (MARSI risk) or subcutaneous systems
- Cosmetic priority (face) → Blend tone strips, fine sutures (early removal), or subcutaneous closure
- Moist/oily skin → Clean thoroughly, consider benzoin, or choose sutures if adhesion unlikely
- Surgical incisions requiring speed → Subcutaneous closure systems like SubQ It! offer stapler speed with superior cosmesis
Frequently Asked Questions
What are reinforced skin closures?
Reinforced skin closures are adhesive strips strengthened with polyester filaments that hold wound edges together without piercing the skin. They provide an alternative to sutures or staples for superficial, low-tension lacerations with lower infection risk and excellent cosmetic outcomes.
Are 3M Steri-Strips reinforced skin closure?
Yes, 3M Steri-Strips are a brand name for reinforced skin closure strips. The term "Steri-Strip" has become a genericized trademark used to refer to all wound closure strips regardless of manufacturer.
How long do Steri-Strips usually stay on?
Steri-Strips typically remain in place for 5-7 days for most wounds, up to 10-14 days for surgical incisions. They will naturally loosen and fall off as the wound heals, though they should be removed earlier if signs of infection appear.
Do wound closure strips work?
Yes, wound closure strips are clinically effective for appropriate wounds. Research shows comparable healing outcomes to sutures for superficial, low-tension lacerations, with advantages including lower infection risk, better cosmetic results, and significantly less pain during application and removal.
What is the adhesive for wound closure?
Wound closure strips use medical-grade, hypoallergenic, pressure-sensitive acrylate adhesive that bonds to skin when firm pressure is applied. Additional skin adhesive (Compound Benzoin Tincture) can enhance strip adhesion in challenging cases, though it may cause allergic contact dermatitis in sensitive patients.
