Suture Material for Lip Lacerations
For lip lacerations, use 5-0 or 6-0 monofilament non-absorbable sutures (nylon or polypropylene) as your first-line choice, as these provide optimal cosmetic outcomes with the lowest infection risk. 1, 2
Primary Suture Selection
Monofilament non-absorbable sutures (nylon or polypropylene) in 5-0 or 6-0 size are the gold standard for lip lacerations because they cause less bacterial seeding and have lower infection rates compared to other suture types. 1, 2
The American College of Surgeons specifically recommends these materials as first-line for facial lacerations, including lips, due to their superior cosmetic outcomes and reduced infection risk. 1
Monofilament sutures demonstrate significantly better soft tissue healing and less inflammatory reaction compared to multifilament or natural sutures. 3
Acceptable Absorbable Alternatives
If suture removal follow-up is problematic or impossible, consider absorbable monofilament options like poliglecaprone (Monocryl) or polyglyconate (Maxon), though these are not first-line. 1, 2
Research demonstrates no difference in long-term cosmetic outcomes between absorbable and non-absorbable sutures for facial wounds in adults with clean wounds. 4
For buried/deep layer closure, absorbable monofilament sutures are actually preferable to non-absorbable materials, as they eliminate the risk of stitch abscesses (14% with non-absorbable vs 0% with absorbable in cleft lip repairs). 5
Materials to Avoid
Never use catgut sutures - they are associated with significantly more pain and higher resuturing rates. 1, 2
Avoid silk and multifilament sutures - silk shows the poorest soft tissue healing, strongest inflammatory reaction, and greatest microbial adherence compared to alternatives. 3
Rapidly absorbing synthetic sutures (Vicryl Rapide) should not be used for the cutaneous portion of lip lacerations, though they may be considered for the mucosal side. 1, 2
Critical Technical Considerations
Precise alignment of the vermillion border is absolutely critical - misalignment results in permanent cosmetic deformity that is immediately noticeable. 1, 6
Use a layered closure approach: start with the deeper muscular layer using absorbable sutures, then close mucosal and skin layers separately. 1, 2
Employ continuous non-locking suturing technique rather than interrupted sutures, as this distributes tension more evenly across the suture line and reduces tissue edema and necrosis risk. 1, 2
Avoid overly tight sutures that can strangulate tissue and impair healing. 1
Post-Repair Management
Remove non-absorbable sutures after 5-7 days to minimize scarring. 1, 2
Keep the wound clean and dry for the first 24-48 hours. 1, 2
Recommend a soft diet to minimize movement and tension on the suture line. 1, 2
Prescribe chlorhexidine 0.12% rinses twice daily for 1 minute for at least the first week to reduce bacterial load. 1, 2
Common Pitfalls
The rich vascular supply of lip lacerations creates significant bleeding potential despite appearing minor - be prepared for this. 1
The increased mobility of the lip area creates additional tension on wounds, making proper suture material selection particularly important. 2
Monitor closely for infection signs: increasing pain, redness, swelling, or purulent discharge. 1, 2
Do not routinely use adhesive steri-strips, as evidence shows no improvement in cosmetic outcomes or scar width when added to buried dermal sutures. 1