Staples, adhesive strips and tissue adhesive

What it is

Many simple wounds can be closed without needle and thread. Skin staples are fast and cause little tissue reaction; they suit straight wounds of the scalp, trunk and limbs, but they are less precise and leave marks, so they are avoided on the face and hands. Adhesive strips are thin reinforced tapes laid across a superficial, straight, low-tension wound or used to support a wound after stitches come out; they need dry skin and do not hold on moist, hairy or mobile areas. Tissue adhesive (2-octyl cyanoacrylate) is a liquid that polymerises into a flexible film on the skin surface, bridging edges that are held together. It is quick, painless, needs no removal and gives a cosmetic result similar to stitches in suitable wounds, which makes it popular in children and on the face. Its key rule is that it goes on top of the closed wound, never into it, because adhesive inside the wound acts as a foreign body and stops healing.

Indications

• Staples: straight lacerations of the scalp, trunk and limbs, and long surgical incisions where speed matters.
• Adhesive strips: superficial, straight, low-tension wounds, skin tears and support after stitch or staple removal.
• Tissue adhesive: clean, straight, low-tension lacerations with edges that come together easily, especially on the face and in children.
• All three: when avoiding injected anaesthetic and stitch removal is an advantage (adhesive and strips).

Contraindications and precautions

• Not for infected, heavily contaminated, bite or puncture wounds, or wounds needing deep layer closure.
• Staples: avoid on the face, neck and hands, and where imaging or precise alignment matters.
• Strips: do not hold on moist, hairy or very mobile skin (joints), and fail under tension.
• Tissue adhesive: avoid on mucosa, the eye, hair-bearing skin, joints and areas of high tension or constant moisture.
• Tissue adhesive: do not use in people allergic to cyanoacrylate or formaldehyde; protect the eye when working near it.

Equipment

• Gloves, irrigation and gauze to clean and dry the wound; local anaesthetic for staples.
• Skin stapler, toothed forceps for eversion, and a staple remover for later.
• Adhesive strips of a suitable width and, optionally, an adhesive-enhancing skin liquid.
• Tissue adhesive applicator; petroleum-based ointment and gauze to protect the eyes or remove stray adhesive.

Step by step (and why)

1. Assess, irrigate and achieve haemostasis, then dry the skin — none of these methods works on a wet or bleeding wound.
2. Staples: have an assistant evert the edges with forceps — staples placed on flat or inverted edges heal into a groove.
3. Staples: hold the stapler at 90° over the centre of the wound, fire without pressing hard and space evenly — avoids deep, tight staples.
4. Strips: apply the first strip across the middle, then fill in with small gaps between strips — gaps let fluid drain.
5. Strips: lay them across the wound without stretching and add strips along each end parallel to the wound — this stops the ends lifting.
6. Adhesive: position the patient so drips run away from the eyes and protect the eye if near — adhesive in the eye bonds the lids.
7. Adhesive: hold the edges together and apply thin layers on top of the closed wound, never into it — inside, it blocks healing.
8. Adhesive: hold the edges until the film sets, then add layers as the product directs — several thin layers are stronger than one thick one.
9. Explain care: no ointments on the adhesive, short showers allowed, no soaking or picking — ointment dissolves the film early.

Complications

• Dehiscence when used on wounds under tension or over joints.
• Adhesive inside the wound: foreign-body reaction, poor healing and a widened scar.
• Adhesive in the eye or bonding the eyelids; a mild warm feeling as it sets.
• Staples: marks, poor alignment and discomfort; infection as with any closure.
• Strips: blisters if stretched over swollen skin, and early lifting on moist skin.
• Allergic contact reaction to adhesive or strip materials.

Next step

• Staples: arrange removal with a staple remover at the time for the site (scalp about 7–10 days).
• Strips: leave them until they lift on their own, usually about a week; trim edges that curl.
• Tissue adhesive: no removal; the film peels off by itself in about 5–10 days.
• Give infection warning signs and check tetanus status.
• Call a senior when the wound does not meet without tension, involves deep structures or is on a high-risk site.

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Elsewhere in DurgiPedia

• Removing sutures and staples
• Wound care and dressings: cleaning and choosing a dressing

Connections

← All clinical skills

Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.

Sources: 2-Octyl Cyanoacrylate (StatPearls (NCBI Bookshelf), 2024); Wound Closure Techniques (StatPearls (NCBI Bookshelf), 2023).

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