From the Guidelines
Chin lacerations should be sutured when they are deeper than the dermis, longer than 1-2 cm, gaping, or in a cosmetically sensitive area, as this approach minimizes the risk of wound dehiscence and infection, as supported by the findings of a Cochrane review 1. When deciding to suture a chin laceration, several factors should be considered, including the depth, length, and location of the wound.
Key Considerations for Suturing Chin Lacerations
- Depth: Lacerations deeper than the dermis are at higher risk of complications and should be sutured to promote proper healing.
- Length: Lacerations longer than 1-2 cm are more likely to benefit from suturing to minimize the risk of dehiscence.
- Location: The chin is a cosmetically sensitive area, and suturing can help minimize scarring.
- Timing: Ideally, suturing should occur within 6-8 hours of injury to minimize infection risk, though clean facial wounds may be sutured up to 24 hours after injury 1.
Suturing Technique
Before suturing, thoroughly clean the wound with saline or antiseptic solution and administer local anesthesia (typically 1-2% lidocaine with epinephrine).
- For chin lacerations, use 5-0 or 6-0 non-absorbable sutures like nylon or polypropylene for the skin closure, placing sutures 2-3 mm apart.
- Deep lacerations require layered closure with 4-0 or 5-0 absorbable sutures like Vicryl for the subcutaneous tissue first.
- Remove skin sutures after 5-7 days to prevent scarring.
Post-Suturing Care
Post-suturing care includes:
- Keeping the wound clean and dry
- Applying antibiotic ointment like bacitracin for 2-3 days
- Watching for signs of infection Suturing chin lacerations is important because proper closure ensures optimal healing, minimizes scarring in this visible area, and reduces infection risk while restoring normal tissue function and appearance, as highlighted in the study 1.
From the Research
Suturing a Chin Laceration
- The decision to suture a chin laceration depends on various factors, including the size and location of the laceration, as well as the patient's overall health and medical history 2, 3, 4.
- Studies have shown that tissue adhesives can be an effective alternative to sutures for repairing chin lacerations, especially in low skin-tension areas 2, 3, 4, 5.
- However, the risk of dehiscence may be higher for chin lacerations compared to other facial localizations, regardless of whether tissue adhesives or sutures are used 2.
- Suturing is still considered the preferred method for laceration repair, but tissue adhesives may be more cost-effective and result in similar patient satisfaction and scarring risk in certain cases 3, 4.
- The use of tissue adhesives for laceration repair has been shown to reduce the length of time required for repair, decrease parental perception of pain, and result in a comparable cosmetic outcome to suturing 5.
Considerations for Wound Management
- The main aims of wound management are to assist in hemostasis, avoid infection and pain, and ensure an esthetically pleasing scar 3.
- Wound management should take into account the whole patient, including treating pain and preventing painful manipulations 3.
- Patient education and appropriate procedural coding are important after the repair 3, 4.
- The use of tap water for irrigation, white petrolatum ointment for postprocedure care, and wetting the wound as early as 12 hours after repair have been shown to be safe and effective 4.