Skin Closure Tapes

Skin-closure tapes are used as an alternative to sutures and staples for wound closure and for additional support after suture and staple removal. 9 Tapes do not require anesthesia and the patient does not need to return for their removal. Skin-closure tapes work best on flat, dry, nonmobile surfaces where the wound edges fit together without tension. Conversely, oily or wet surfaces, movable areas, or wounds that stay open with tension are not appropriate for surgical tape closure. Taped wounds are more resistant to infection than sutured wounds; therefore tapes are useful for wounds at increased risk of infection. Tapes can be used for skin flaps, where sutures may compromise perfusion, and for lacerations with thin, friable skin that will not hold sutures.

The ease with which wounds can be closed by tape varies according to the anatomic and biomechanical properties of the wound site. Linear cutaneous wounds subjected to minimal static and dynamic tensions are easily approximated by tape. The relatively lax skin of the face and abdomen makes it amenable to wound closure by tapes. Contrary to expectation, tape closure without sutures is more easily accomplished in obese patients, and the thick cut edges of adipose tissue tend to evert the skin. The taut skin of the extremities, which is subjected to frequent dynamic joint movements, requires dermal sutures before taping. The copious secretions from the skin of the axillae, palms, and soles discourage tape adherence.

A variety of skin-closure tapes are commercially available, with differing biomechanical characteristics. The ideal tape should primarily possess excellent adhesion

1 i and strength; porosity, flexibility, and elasticity are less important. In the United States, tapes sold for ED use come in widths of 4 and 2 in., in varying lengths, in

1 1 sterile, single-use packages. The 4-in. width is appropriate for wounds less than 3 to 4 cm in length; longer wounds should use the 2-in. width. The individual tapes are applied to nonadherent backing that can be bent at a scored perforation to free up one end of the tape without deforming it. The tapes should be removed from the backing by grasping the free end with forceps.

Adherence of tapes is enhanced by the use of benzoin or mastic to the skin surface 2 to 3 cm beyond the wound edges. These agents are best applied with applicator sticks or applicator-tipped single-use vials. Care should be taken not to allow any benzoin or mastic to enter the wound. The agent should be allowed to dry and become tacky before the tape is applied.

Tapes should be long enough to stretch 2 to 3 cm on either side of the wound. Using forceps, the tape is attached to the skin on one side, then pulled across the wound to coadapt the wound edges and applied to the opposite side. Coadaption of the wound edges can be facilitated by using a finger to push the wound together as the tape is being pulled across. Longitudinal alignment of the wound edges is facilitated when taping starts in the middle and progresses toward each end. Individual tapes are applied with some space between them but not so much that the wound edges gap open between the individual tapes ( Fig 37-10).

FIG. 37-10. Skin-closure tapes should be applied perpendicular to the wound edges and spaced so that the edges do not gape.

When skin-closure tapes are properly employed to close linear wounds subjected to weak tensions, cosmetic results are excellent. Additionally, the discomfort of anesthetic infiltration, the need for suture removal, and the development of suture puncture scars is avoided. Wounds closed with tape cannot get wet or be washed. Dressing over a taped wound is problematic; on the one hand, the dressing may protect the tape ends from becoming lifted, but, on the other, a dressing may promote the collection of moisture and premature tape separation. Tapes should stay in place about as long as an equivalent suture and will spontaneously detach as the underlying epithelium exfoliates.

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