What is the recommended management for a lip suture?

Lip Suture Management

For lip lacerations requiring suturing, remove non-absorbable sutures at 3-5 days post-placement to optimize cosmetic outcomes and minimize scarring, or preferentially use absorbable sutures to eliminate the need for removal entirely. 1

Suture Removal Timing

• Remove facial/lip sutures within 3-5 days due to the excellent blood supply of the face that accelerates healing and the critical importance of minimizing visible scarring in this cosmetically sensitive area 1
• Delayed removal beyond 5 days significantly increases the risk of permanent suture marks, tissue reaction, and infection 1
• The face requires the earliest suture removal of any body location compared to scalp (7-10 days), trunk, or extremities (10-14 days) 1

Optimal Suture Selection for Lip Repair

Absorbable sutures are strongly preferred for lip closure to eliminate the pain and anxiety of suture removal while providing comparable or superior outcomes 1, 2, 3

Evidence Supporting Absorbable Sutures:

• Absorbable sutures (polyglyconate, polydioxanone) result in zero stitch abscesses compared to 14% with non-absorbable nylon (p=0.007), with no significant difference in cosmetic scar appearance at 12 months 2
• Fast-absorbable sutures like irradiated polyglactin 910 (Vicryl Rapide) can be successfully used for oral/lip surgery without affecting healing outcomes 4
• Monofilament absorbable sutures (poliglecaprone 25/Monocryl) provide excellent handling properties, minimal tissue drag, and maintain 20-30% breaking strength retention through the critical 2-week wound healing period 5

Comparative Outcomes:

• While non-absorbable sutures may show slightly more favorable cosmesis in some studies, this advantage is overshadowed by significantly higher postoperative complications 3
• Tissue reactivity is more common with absorbable sutures, particularly on postoperative day 7, though this does not translate to worse long-term outcomes 6

Alternative Closure Methods

• Tissue adhesives provide painless closure for low-tension lip wounds but carry a 3-fold increased risk of wound dehiscence (RR 3.35,95% CI 1.53-7.33) compared to sutures 1
• Tissue adhesives should be reserved for superficial, low-tension wounds where the risk-benefit profile favors avoiding sutures entirely 1

Pre-Removal Assessment

Before removing non-absorbable sutures at 3-5 days:

• Verify adequate wound healing by checking for wound edge approximation and absence of tension 1
• Assess for any wound oozing, which should not be assumed to resolve spontaneously and requires immediate attention 1
• Consider patient factors (age, comorbidities, medications) that may affect healing and warrant slight timing adjustments 1

Post-Removal Care

• Keep the area clean and dry after suture removal 1
• Apply Steri-Strips for additional support if any tension remains across the wound, though evidence shows they do not improve cosmetic outcomes when used with buried dermal sutures 1
• Monitor closely for wound separation in the first 24-48 hours post-removal 1

Critical Pitfalls to Avoid

• The most critical error is leaving facial/lip sutures in place beyond 5 days, which significantly increases scarring risk in this cosmetically sensitive area 1
• Removing sutures before 3 days risks wound dehiscence and widened scars, especially in areas of facial movement 1
• When using fast-absorbable continuous sutures, add interrupted "security sutures" to reduce the risk of wound dehiscence 4
• Do not ignore small amounts of wound oozing, as they require immediate intervention to prevent complications 1