A trick in steri-strips application: the zig-zag pattern.

Dear Editors, Adhesive strips are a fundamental device to achieve better wound closure, sometimes avoiding superficial sutures. Time-effective removal, easy application and early detection of infections are the key points to fulfill. An easy manner to achieve those goals is herein presented. As stated in a paper by Katz et al., steri strips are used in a number of settings: for adjunctive wound support after stitch removal or in conjunction with buried dermal or absorbable running subcuticular sutures in low-tension wounds (1). Adhesive surgical tape originated as a wound dressing, being laid without tension over and in line with the surgical wound. It evolved as a method of wound closure, applied perpendicular to the wound and with tension. This arrangement increases the inward elastic recoil of the tape, theoretically aiming to relieve outward forces that favour dehiscence of the wound edges. Modern operative surgical techniques recommend, despite a lack of proved evidence, a wound closure method of continuous absorbable subcuticular suture, reinforced by adhesive tape (2,3). Studies have shown that taped closure has the advantages of lower wound infection rates and greater wound tensile strength, but also the disadvantages of skin edge inversion, unsure safety and the time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. In our series, double closure technique using both subcuticular sutures and natural skin tone color adhesive strips is usually performed. As evidenced by the literature, steri strips are usually positioned perpendicularly to the wound and parallel to one another in a non-overlapping fashion. Other authors suggest, in certain circumstances, application of adhesive tape parallel to the wound in order to prevent the formation of blisters and shearing effect on the skin (4). However, according to our experience, another useful and effective manner to place them is to arrange them head-to-tail, diagonally to the wound and perpendicular to each other (‘zig-zag’ pattern), such that the underlying wound could be seen. Furthermore, strips of half the width would be sufficient (Figure 1). There are several reasons why this solution is preferable. Firstly, the distribution of tension forces is excellent. All the stitches are positioned in order to create a continuous line, with uniform strength applied all over the wound. Moreover, sliding of the wound margins is prevented, thanks to opposite stabilizing forces. Secondly, removal is extremely easy and rapid. In fact, the advantage of the continuous line is linked to the possibility to pull the tail on one side and a little later to raise the head on the other one. Figure 1 The picture clearly shows the use of a ‘zig-zag’ pattern of steri-strips application, reinforcing a subcuticular suture.