• 
• 

Three Part Question

In [elderly patients with pretibial lacerations] are [adhesive strips or sutures] better at [promoting rapid healing and minimising necrosis and infection]?

Clinical Scenario

A 70 year old woman presents to the Emergency Department with a pretibial flap laceration. The wound will need cleaning and then closing. You wonder whether adhesive strips or sutures should be used to achieve closure.

Search Strategy

Medline 1966-03/00 using the OVID interface.
{exp tibia OR tibia$.mp OR pretibial.mp OR pre tibial.mp OR shin$.mp} AND [({tape$.mp OR strip$.mp} AND {exp adhesives OR adhesive$.mp}) OR steristrip$.mp] LIMIT to human AND english.

Search Outcome

5 papers found of which 4 irrelevant or of insufficient quality for inclusion. The one remaining paper is shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Sutton R and Pritty P 1985 UK	45 patients with pretibial flap lacerations. Sutures (22) vs steristrips (23) 31 patients with pretibial linear lacerations. 31 patients with pretibial linear lacerations. Sutures (15) vs steristrips (16)	PRCT	Healing time	53 days vs 39 days	Small numbers
			Number of wounds with necrosis	16 vs 8
			Number of infected wounds	7 vs 7
			Number requiring rescue grafting	3 vs 3
			Healing time	25 days vs 23 days
			Number of wounds with necrosis	3 vs 0
			Number of infected wounds	2 vs 2
			Number requiring rescue grafting	none

Comment(s)

This study shows that pretibial lacerations heal faster with steristrips and exhibit less necrosis. This effect is more marked for flap lacerations. The study does not address the question of primary grafting of these injuries.

Clinical Bottom Line

Pretibial lacerations should be steristripped rather than sutured.

References

1. Sutton R, Pritty P. The use of sutures or adhesive tapes for primary closure of pretibial lacerations BMJ 1985;290:1627.