impractical for small children, who may inadvertently remove them from the wound Tissue adhesives, or skin glues, such as octyl cyanoacrylate have become widely used for wound closure in the ED They allow rapid and painless closure of wounds, though if glue gets into the wound, it can cause a burning sensation or pain Anesthesia is unnecessary, unless painful irrigation or exploration of the wound are anticipated No removal is needed because adhesives slough off after to 10 days They provide an excellent cosmetic result, comparable with sutures One study using plastic surgeons blinded to the method of repair graded the wounds repaired with tissue adhesives to be cosmetically equal to sutured wounds at 2-month and 1-year follow-up visits For scalp lacerations, hair apposition technique (HAT) can be performed with skin glue A few strands of hair on either side of the scalp laceration are separated, pulled across the wound in opposite directions (pulling together the laceration), twisted together with glue applied to the twisted region, and repeated along the length of the wound HAT is a painless method of repairing scalp wounds that don’t require follow-up for stitch or staple removal Tissue adhesives act to decrease wound infections because they have antimicrobial effects against gram-positive organisms Dehiscence rates (1% to 3%) are similar to that of sutured wounds They are less expensive than sutures because less equipment is required and personnel time is reduced Studies have noted that some patients and families of small children prefer skin adhesives to sutures Routine follow-up is not needed for uncomplicated wounds, and no longterm complications have been reported Newer products such as high-viscosity octyl cyanoacrylate tissue adhesives are less likely to migrate during repair, making wound repair easier to accomplish Before application of the tissue adhesive, the wound is cleaned and hemostasis is achieved with dry gauze and pressure The wound’s edges are held together manually or with forceps while the tissue adhesive is applied along the surface of the wound The tissue adhesive should not be applied to the inside of the wound because it will act as a foreign body and inhibit healing The wound edges are held in place for about 20 to 30 additional seconds to obtain adequate bonding If poor alignment of wound edges is noted, the adhesive can be removed with forceps and reapplied without further complication The wound is then covered carefully so adhesive portions of any bandage not directly contact the skin glue, to avoid pulling off the tissue adhesive with dressing changes Avoid routine application of antibiotic ointments by parents as these will dissolve the adhesive and cause dehiscence