How is a through-and-through complex lip laceration closed?

Updated: May 03, 2018
  • Author: Gretchen S Lent, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

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.

 

Extraoral approach to close the deep layer. Extraoral approach to close the deep layer.

 

Wound approximation after 2 deep sutures are place Wound approximation after 2 deep sutures are placed.

Intraoral approach to close the deep layer. Intraoral approach to close the deep layer.
Wound approximation after placement of deep muscul Wound approximation after placement of deep muscular sutures.

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.

 

Placement of the first suture through the vermilio Placement of the first suture through the vermilion border.

 

Placement of the first suture through the vermilio Placement of the first suture through the vermilion border.
First suture aligning the vermilion border. First suture aligning the vermilion border.

*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.

 

Closure of an intraoral skin laceration. Closure of an intraoral skin laceration.
Placement of intraoral skin suture with buried kno Placement of intraoral skin suture with buried knot.
Closure of an intraoral laceration. Closure of an intraoral laceration.

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.

 

Complete closure of the facial skin. Complete closure of the facial skin.
Complete closure of the facial skin. Complete closure of the facial skin.

*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]


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