Answer
Through-and-through lip wounds are closed in subsequent layers.
Deep soft-tissue layer
Use 4-0 or 5-0 absorbable sutures such as Vircyl to anchor the fibrous tissue just underneath the anterior and posterior skin surfaces. In deep but not through-and-through lacerations, deep sutures can be placed using a simple interrupted technique that leaves the knot buried deep within the laceration. See the images below.
Vermilion border
If the vermilion border is involved, approximate it with the first suture placed on facial skin. Use 6-0 suture material.* The approximation of the vermilion-cutaneous junction is the most crucial step in the closure of lip lacerations that involve the vermilion border. Misalignment of even 1 mm may cause a noticeable step-off when the wound is healed. See the images below.
*In young children, consider using all absorbable sutures for repair of these lacerations. Eliminating the need for suture removal may result in decreased emotional and physical trauma, and studies show no discernable difference in cosmetic outcome. [14] This is also an excellent option in adults. Fast-absorbing sutures are recommended.
Intraoral skin
Intraoral skin may be closed either before or after the facial skin. Approximate the buccal wet mucosa with simple interrupted absorbable sutures (4-0 or 5-0); absorbable sutures fall out or absorb and do not require removal. However, do not use fast-absorbing sutures on mucosal surfaces. Secure each stitch with 4 or more knots to ensure that the stitches are not untied by the tongue. These sutures can be continued onto the wet and dry vermilion surface of the lip. Silk is best avoided in the mouth, as it can irritate mucosal tissues. Any small intraoral flaps may be excised. See the images below.
Facial skin
Using 6-0 sutures,* approximate the skin with simple interrupted sutures. This suture material can be continued onto the lip. Many prefer absorbable sutures on the dry vermilion surface. See the images below.
*In young children, consider using all absorbable sutures for repair of these lacerations. Eliminating the need for suture removal may result in decreased emotional and physical trauma, and studies show no discernable difference in cosmetic outcome. [14]
-
Equipment for the anesthesia, irrigation, and closure of a lip laceration.
-
Lip laceration involving the lower vermilion border.
-
Identification of intraoral skin laceration.
-
Lip laceration involving the upper vermilion border.
-
Deep intraoral lip laceration that needs repair.
-
Technique for extraoral infraorbital nerve block.
-
Intraoral approach for infraorbital nerve block.
-
Placement of the first suture through the vermilion border.
-
Assessing for mobile or broken teeth.
-
Further inspection of the anesthetized wound reveals a through-and-through laceration.
-
Extraoral approach to close the deep layer.
-
Wound approximation after 2 deep sutures are placed.
-
First suture aligning the vermilion border.
-
Placement of intraoral skin suture with buried knot.
-
Closure of an intraoral skin laceration.
-
Closure of an intraoral laceration.
-
Intraoral approach to close the deep layer.
-
Wound approximation after placement of deep muscular sutures.
-
Placement of the first suture through the vermilion border.
-
Placement of the first suture through the vermilion border.
-
Complete closure of the facial skin.
-
Complete closure of the facial skin.
-
Illustration of the upper and lower vermilion border.
-
Areas of regional nerve blocks for the lips.
