What is the management for a through and through lip laceration that is well approximated?

From the Guidelines

Management of a well-approximated through and through lip laceration should prioritize primary closure in layers, with careful attention to cosmetic outcome and infection prevention, as recommended by the Infectious Diseases Society of America 1. The approach involves several key steps:

• Clean the wound thoroughly with normal saline or sterile water to reduce the risk of infection.
• Administer local anesthesia using 1-2% lidocaine with epinephrine (1:100,000) for pain control and hemostasis.
• Align and suture the vermilion border precisely with 6-0 non-absorbable sutures to ensure proper cosmetic alignment.
• Close the oral mucosa using 5-0 or 6-0 absorbable sutures, followed by approximation of the muscle layer with 5-0 absorbable sutures.
• Finally, close the skin with 6-0 non-absorbable sutures and remove them in 5-7 days to minimize scarring. It is also crucial to prescribe oral antibiotics, such as amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days, to prevent infection, given the bacterial load in the oral cavity 1. Additional recommendations include chlorhexidine 0.12% oral rinse after meals and a soft diet for 7-10 days, along with pain management using acetaminophen or ibuprofen as needed. Proper wound care, including keeping the area clean and applying antibiotic ointment to the external portion of the wound, is essential for optimal healing and minimizing complications 1.

From the Research

Management of Through and Through Lip Laceration

The management of a through and through lip laceration that is well approximated involves several key steps:

• Cleansing the wound with irrigation under pressure to reduce the risk of infection 2
• Examining the wound radiographically if necessary and debriding devitalized tissue to promote healing 2, 3
• Achieving accurate coaptation of the dermis to ensure strong wound closure, as the skin's greatest strength is in the dermal layer 2
• Considering the use of nonsterile gloves and potable tap water for irrigation, as these do not increase the risk of wound infection 4
• Using local anesthetic with epinephrine in a concentration of up to 1:100,000 for digital blocks and 1:200,000 for nasal and ear repairs, but noting that the evidence does not specifically address lip lacerations 4
• Applying tissue adhesives or wound adhesive strips in low-tension skin areas, but recognizing that lip lacerations may require more precise repair techniques 4, 5
• Providing tetanus prophylaxis if indicated and considering occlusive or semiocclusive dressings to promote a moist environment for faster healing 4
• Removing sutures based on the location of the wound and expert opinion, with the timing depending on factors such as tension on the wound and the patient's overall health 4

Specific Considerations for Lip Lacerations

Lip lacerations, especially those involving the vermilion border, require precise repair for a good cosmetic outcome 5

• The lips are a highly visible facial structure, consisting of skin, muscle, and oral mucosa, and are used for speech, food consumption, and tactile sensation 5
• Lacerations greater than 25% of the lip can be particularly challenging and deforming, emphasizing the need for careful management 5

Irrigation and Infection Risk

Irrigation before primary closure may not significantly alter the rate of infection or cosmetic appearance in clean, noncontaminated facial and scalp lacerations, including lip lacerations 6

• However, irrigation is still recommended to reduce tissue contamination and promote healing, especially in contaminated wounds 2, 3