As part of a short series on very basic principles of wound closure we are going to discuss the use of adhesive strips. This practical advice is intended offer some guidance in the use of adhesive strips, assumes the full assessment of the wound has already occurred and the wound is suitable for this method of closure.
Adhesive strips are more commonly known as SteriStrips but this actually a trademark of one particular product. A bit like when you say you are going to “Hoover”. You may also hear them referred to as butterfly stitches/strips.
They are useful in the closure of superficial wounds. However, it is important that the skin surface is smooth, dry, clean and relatively hair free to allow the strips to adhere. If this is not the case it may be better to use tissue adhesive.
Prior to closure the wound should be fully assessed, and cleansed in an appropriate manner.
It is important when using adhesive strips that the skin surface surrounding the wound is dry. The adhesive used in these strips is water soluble so will not stick to the skin surface if it is moist, or if the wound is bleeding more than a minimal amount. Additionally, an oily surface may prevent adhesion, such as if the patient has used a moisturiser. In this case it may be useful to clean around, but not over, the wound with an alcohol swab. Another useful technique where strip adhesion is proving difficult due to oil or light moisture is to apply some tissue adhesive to the skin at the borders of the wound where the strips will stick, allow to dry and then apply the adhesive strip. This will provide a better surface for the strips to key into.
The strips can be cut to a shorter length once removed from the packaging using sterile scissors.
It is sometimes necessary, on wounds that are particularly large, unstable or under tension, to apply one or more ‘sacrificial’ strips to gain a good effect. It maybe that these strips don’t fully oppose the wound, or are under and undesirable amount of tension. However, once you have secured the wound as shown above, these can be removed and the closure completed with further strips.
It is not necessary to apply a dressing over every wound, but on occasion this might be useful if the wound is still lightly bleeding, or in order to protect the wound from contamination or if you or the patient/carer feels the patient might scratch or pick at the wound.
It is paramount that the strip be kept dry until the wound is healed or they will start to come away. It is also not uncommon for the wound to rub on clothing or bedding, and the end of the strips start to roll up. If you wish to provide a more secure hold to the strips then it is acceptable to use a little tissue adhesive on the ends of the strips, away from the wound, in order to provide a more robust adhesion that is slightly more water resistant. I would also strongly recommend always using some anchoring strips as shown in the video.
All patients and / or their carers should be provided with verbal and written wound care advice, including signs of infection. This can be found here.
