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Lip laceration:

Slide 1: Laceration of the lip is an injury commonly seen in emergency


departments. Careful repair is necessary to ensure the best cosmetic results; even
1 mm of vermilion misalignment may be noticeable.

Slide 2: Equipment for lip laceration repair includes anesthesia (topical anesthetic,
lidocaine, 10-mL syringe, and 18- and 27-gauge needles), irrigation (sterile saline or
water, syringe or irrigation device, splash shield, and basin), suture materials
(absorbable and nonabsorbable sutures, suture tray/kit), and personal protective
equipment (gloves, gown, face shield).

Slide 3: The vermilion is the white roll that forms the free border of the lip at the
cutaneous junction. Complex lip lacerations can affect the upper or lower vermilion
border. The vermilion border must be aligned properly during laceration repair for
best cosmetic results.

Slide 4: This lip laceration involves the lower vermilion border.

Slide 5: Intraoral laceration. This injury also resulted in an intraoral skin laceration,
which is identified here. Unlike the cosmetically important facial lacerations that are
almost always closed primarily, certain small intraoral lacerations (< 2 cm; will not
interfere with chewing or trap food particles) may be left open without repair. In this
case, the intraoral laceration needed to be repaired.

Slide 6: Anesthesia - To avoid the swelling caused by local infiltration of anesthesia,


a regional nerve block is recommended. Be sure to test the adequacy of anesthesia
before proceeding with repair.

Slide 7: Irrigation (7) - Intraoral wounds are prone to considerable contamination;


therefore, thorough irrigation is necessary.

Slide 8: Closure of muscular layer. Close the muscular layer first. Use 4-0 or 5-0
absorbable sutures 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.

Slide 9: Wound approximation Approximate the wound after 2 deep sutures are
placed.
Slide 10: Vermilion border alignment. If the vermilion border is involved,
approximate it with the first suture placed on facial skin. Use 6-0 nonabsorbable
suture material.

Slide 11: First suture in place. In this image, the first suture aligning the vermilion
border is in place. 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.

Slide 12: Closure of intraoral laceration. If an intraoral laceration must be repaired,


it 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). Secure each stitch
with 4 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.

Slide 13: Silk is best avoided in the mouth as it can irritate mucosal tissues. Any
small intraoral flaps may be excised. Absorbable sutures fall out or absorb and do
not require removal.

Slide 14: Complete closure of facial skin. After the first suture is in place,
approximate the skin with simple interrupted 6-0 nonabsorbable sutures. This
suture material can be continued onto the lip; however, many surgeons prefer
absorbable sutures on the dry vermilion surface.