Steri-strip and Suture Combo Technique for Repairing Fragile Skin
Old people. They come with all sorts of problems and complications. Even simple lacerations are more complicated with them. Have you ever encountered a laceration in an elderly patient whose skin was just so fragile and thin that even your suture just tears right through the skin edges? In these situations, you can try to use steri-strips, but these often provide inadequate approximation and closure, especially in higher tension areas. So what’s a savvy ED physician to do in these situations?
Here’s a trick to try next time you encounter one of these. Consider using a combination of steri-strips and sutures to close the wound. You can place steri-strips along the wound edges. Then, you can suture the wound edges through the steri-strips, which will help hold the skin together and prevent tearing. This can be done with simple interrupted sutures or any other method that works for the wound in question. Tie off the knots over the steri-strips as if they weren’t there. Leave the steri-strips in place until there is adequate wound healing, which could even be up to weeks. The sutures should still come out in the usual timeline, whether a few days or a week depending on location of wound. Make sure to counsel the patient on signs of infection as the steri-strips may obscure your view of the wound edges while they are on there.
This combination technique first appeared in the plastic surgery literature in 2009. It has also been described in the Journal of Emergency Medicine in 2011. Give it a try next time in the ED.
Check out the video and websites below for more info.