Daams F, A vermilion border with as little as 2 mm of malalignment may produce a cosmetic defect. Cartilage has poor circulation and is prone to infection and necrosis. Complex Vermilion Border Lip Lacerations. If there is no concern for vascular compromise to an appendage, local anesthetic containing epinephrine in a concentration of up to 1:100,000 is safe for use in laceration repair of the digits, including for digital blockade. The mattress sutures: vertical, horizontal, and corner stitch. Data Sources: The authors used an Essential Evidence summary based on the key words facial laceration, laceration, and tissue adhesives. Korting HC, 22. Vermilion border. Head wounds may be repaired up to 24 hours after injury.8 Factors that may increase the likelihood of infection include wound contamination, laceration length greater than 5 cm, laceration located on the lower extremities, and diabetes mellitus.9. About one-third of foreign bodies may be missed on initial inspection.6. Epidemiology and Prevention of Vaccine-Preventable Diseases. An article on wound care was previously published in American Family Physician.2, When a patient presents with a laceration, the physician should obtain a history, including tetanus vaccination status, allergies, and time and mechanism of injury, and then assess wound size, shape, and location.3 If active bleeding persists after application of direct pressure, hemostasis should be obtained using hemostat, ligation, or sutures before further evaluation. Timing of suture removal depends on location and is based on expert opinion and experience. New York, NY: Thieme, 2008. This div only appears when the trigger link is hovered over. Komolafe EO, Surg Gynecol Obstet. Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives.
This means, making sure the pink contour of the lip remains perfectly aligned. Breuninger H. Einarson TR, 10(May 15, 2017)
Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours after injury. Zelac DE, 1988;17(5):496–500. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study. firstname.lastname@example.org for copyright questions and/or permission requests. Lip laceration involving the upper vermilion border. Moscati RM, *—A variety of needles are available to order, but the most typical needles likely to be stocked are listed. Involvement of the Vermillion border should be the first approximated suture on the skin layer- this is an appropriate skill for emergency physicians, but is best to consider your local practice patterns. Grem C, Malhotra AK, 2007;8(4):232–239. Am J Surg. 2004;20(8):519–524. They should be avoided on the digits, nose, and ear lobes, prilocaine is not approved by the U.S. Food and Drug Administration for nonintact skin, although it has been used this way in numerous studies, Information from Young KD. The impact of wound age on the infection rate of simple lacerations repaired in the emergency department. Georgoulis AD. Eliya-Masamba MC, Clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Carr DB. Foote J, Singer AJ, 44. A regional block of the mental or infraorbital nerve is recommended for anesthesia to avoid additional tissue edema and anatomic distortion produced by local infiltration. To remove dry adhesive, petroleum-based ointment should be applied and wiped away after 30 minutes. Cosmetic outcomes of facial wounds repaired without deep dermal sutures are similar to layered closure.37 The approach to repair varies by wound location. Approximate Synonyms. Jehle DV. Arora BP. Cummings P, Algorithm for the management of acute lacerations. 37. 2013;148(2):190–201. Rosens Chapter 42 - Facial Trauma Essentials of skin laceration repair. Taylor DD. Wang L, 46. Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury. Ellis R, Valentine SM, Reardon RF, 2001;8(7):716–720. It has a prominence on the face, creating a focus for cosmetics … Parrotti D, ‡—Yes, if it has been more than 10 years since the last dose of a tetanus toxoid–containing vaccine. Gantsos A, Laceration repair; External Links References. Yoshikawa M, Rodeheaver GT. Lau J, Assessing for mobile or broken teeth. Tetanus In: Hamborsky J, Kroger A, Wolfe C, eds. Previous: Should Screening Techniques for Colorectal Cancer All Have an 'A' Recommendation? Lucchesi M. Ji-bo Z, Marchini S, LIP LACERATION THROUGH VERMILION BORDER. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. With the large laceration shown, this is not really normal lip anatomy and is, at best, misleading to novice readers.--AaronM 00:48, 9 August 2009 (UTC) Anderson MA, 1. Address correspondence to Randall T. Forsch, MD, MPH, University of Michigan Medical School, 1301 Catherine, Ann Arbor, MI 48109-5624 (e-mail: email@example.com). All sutures are lost if one suture is cut by mistake or removed for drainage, Can cause skin necrosis and excessive scars, Most effective in everting triangular wound edges in flap repair, Fast and effective in accurate skin edge apposition, Suited for closing clean wounds, such as surgical wounds in the operating room, Effective in accurate skin edge apposition and wound eversion, Should be avoided if cosmetic outcome is important, Used to approximate clean, simple, small lacerations with little tension and without bleeding. This patient suffered vermilion border lacerations in two areas from an assault with a broken bottle. Kovar FM. Water for wound cleansing. 2013;(10):CD008574. Antibiotics to prevent infection of simple wounds: a meta-analysis of randomized studies. Wound irrigation with tap water. / afp
Li-song H, *University of Rochester School of Medicine and Dentistry Rochester, NY Lacerations of the lip are a common injury seen in a pediatrician’s office. Fine nonabsorbable suture material (e.g., 6-0 nylon or Prolene) is most appropriate for the skin surfaces of the lip, whereas a fine absorbable suture (e.g., 6-0 Dexon or Vicryl) is quite acceptable for use on the mucosa and vermilion. Br J Neurosurg. Quantitative microbiology: its application to hand injuries. Hogan ME, Gallagher EJ. Linda S. Parlin, MD, Clinical Assistant Professor of Surgery* 1. Bite wounds with a high risk of infection, such as cat bites, deep puncture wounds, or wounds longer than 3 cm,43 should be treated with prophylactic amoxicillin/clavulanate (Augmentin).47,48 Clindamycin may be used in patients with a penicillin allergy.49, Physicians should use the smallest suture that will give sufficient strength to reapproximate and support the healing wound.50,51 Commonly used sutures are included in Table 250,51; however, good evidence is lacking regarding the appropriate suture size for laceration repair. Essentials of skin laceration repair. 2002;(3):CD003326. No: When It Comes to Colorectal Cancer Screening, Test Choice Matters, Next: Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK, Home
20. 1999;29(9):874–879. Kilgore ES Jr. Acad Emerg Med. Cooney DS, Med J Aust. Place 1st stitch with 6-0 nonabsorbable suture to align edges of vermilion border; Then repair rest of lip in usual manner; Disposition. Lip lacerations involving the vermilion border present a unique clinical situation, since relatively minor malalignment may produce an unacceptable cosmetic result. 59. Surg Today. Janicke DM, Ann Emerg Med. Codes 40650-40654 may be appropriate for repair of laceration or surgically created wounds, according to AMA CPT® Assistant (July 2000). Zelac DE, 1975;62(12):952–955. Forsch RT. Rui-feng C, Quinn JV, 2008;78(8):948. a randomised controlled trial. Laceration of upper or lower eyelid skin can be repaired with 6-0 nylon sutures. Hartling L, Ann Emerg Med. Debridement: an essential component of traumatic wound care. The edges of the eyebrow serve as landmarks, so the eyebrow should not be shaved. Shridharani SM, Edlich RF. A comparison of dexon (polyglycolic acid) sutures with other commonly used sutures in an accident and emergency department. Laceration Repair: A Practical Approach. The nature of the laceration depend on characteristics such as angle, force, depth, or object and some wounds can be serious, reaching as far as deep tissue and leading to serious bleeding. vanderVaart S, 1998;5(11):1076–1080. Zehrer CL, A prospective study of two methods of closing surgical scalp wounds. A 7 year old boy presents to the emergency department having fallen in the playground, sustaining a laceration to his bottom lip which crosses the vermilion border. Newmeyer WL III, If the galea is lacerated more than 0.5 cm it should be repaired with 2-0 or 3-0 absorbable sutures.39 Skin can be repaired using staples; interrupted, mattress, or running sutures, such as 3-0 or 4-0 nylon sutures; or the hair apposition technique (Figure 535). Berk WA, Studies have been unable to define a “golden period” for which a wound can safely be repaired without increasing risk of infection. Knoop KJ, Stack LB, Storrow AB, Thurman R. Knoop K.J., & Stack L.B., & Storrow A.B., & Thurman R(Eds. 2014;31(2):96–100. Wound irrigation with tap water. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Emerg Med J. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. Plast Reconstr Surg. Cevik Y, Oldham G, 2014;37(4):183–188. Am Fam Physician. Xia Y, 1976;143(5):775–778. Fernandez R, Immediate, unlimited access to all AFP content. Greenway HT, Lyle CT, Many aspects of laceration repair have not changed over the years, but there is evidence to support some updates to standard management. A randomized controlled trial of buffered lidocaine for local anesthetic infiltration in children and adults with simple lacerations. lip laceration through vermilion border An optimal cosmetic result depends on reapproximation of the vermilion border. She is also an attending physician at the Comprehensive Wound Care Clinic, University of Michigan. Cochrane Database Syst Rev. Injury. Risk factors for infection in patients with traumatic lacerations. Patient information: See related handout on taking care of healing cuts. Osbourne DD, Reardon RF, A meta-analysis of 19 studies of skin closure for surgical wounds and traumatic lacerations found no significant difference in cosmetic outcome, wound infection, or wound dehiscence between absorbable and nonabsorbable sutures.52,53 A systematic review did not show any advantage of monofilament sutures over braided sutures with regard to cosmetic outcome, wound infection, or wound dehiscence.54, The two types of tissue adhesive available in the United States are n-butyl-2-cyanoacrylate (Histoacryl Blue, PeriAcryl) and 2-octyl cyanoacrylate (Dermabond, Surgiseal). Manson PN, Patients who have not had at least three doses of a tetanus vaccine or who have an unknown tetanus vaccine history should also receive a tetanus immune globulin. Villez PA. An unapproximated vermilion margin of 2 mm or greater results in a cosmetic deformity. Francis GJ, Tissue adhesives for traumatic lacerations in children and adults. Raasch B, Concern for peripheral vascular compromise should be considered a contraindication to the use of an epinephrine-containing anesthetic. Somerville, NJ: Ethicon Inc.; 2007. Placing a single suture at each margin first ensures good alignment.37. Antibiotic prophylaxis for mammalian bites. Always carefully place the first skin suture at the vermilion border in any lip laceration. Approximately 6 million patients present to emergency departments for laceration treatment every year.1 Although many patients seek care at emergency departments or urgent care centers, primary care physicians are an important resource for urgent laceration treatment. Cochrane Database Syst Rev. Newmeyer WL III, The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves. The safety and efficacy of epinephrine in hand surgery: a systematic review of the literature and international survey. Kanegaye JT, Rutledge T, Line up the vermilion border with care Lip lacerations crossing the vermillion-cutaneous border, the pink, contoured border between the lip tissue and surrounding skin, are especially prone to a poor cosmetic outcome. A comparison of dexon (polyglycolic acid) sutures with other commonly used sutures in an accident and emergency department. Magarakis M, Osmond MH, Comparison of different suture techniques. Nick TG, Paschos NK, Oberleitner G, Enu IK, Chan L, Pack S. Slieker JC, Ann Plast Surg. The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Otherwise it is hidden from view. 2013;13:e27. Clin Pediatr Emerg Med. After closure of the deeper tissue, the 1st skin suture is always placed at the vermilion border to reestablish the anatomic margin. Bartfield JM, There are no significant studies to guide technique choice. Reprinted with permission from Forsch RT. Schonfeld N. 2013;3(1). Sriharan S, Whitaker IS, Worster B, Want to use this article elsewhere? Adv Surg. Adeolu AA, 12. Philadelphia, Pa.: Elsevier/Saunders; 2014. Rice W. Yadav K, Badawy A, Allchildren with lacerations should be fasted from arrival. 32. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Re-evaluation of wound in 48-72 hours; Removal of non-absorbable sutures in 3-5 days; See Also. Gartner M, Hsieh C. Batrick N, Rutledge T, Perelman VS, Care should be taken to avoid getting tissue adhesive into the wound or accidentally adhering gauze or instruments to the wound. One analysis suggests that wound adhesive strips are the most cost-effective method of closure for appropriate low-tension wounds.56 The strips are applied perpendicular to the vector of the wound to approximate and secure the edges. Armstrong A. Henton J, Shofer FS. Emergency treatment on facial laceration of dog bite wounds with immediate primary closure: a prospective randomized trial study. Kimber D. 2001;(2):CD001738. LAT (lidocaine-adrenaline-tetracaine) versus TAC (tetracaine-adrenaline-cocaine) for topical anesthesia in face and scalp lacerations. Prospective randomised controlled trial of wound management in general practice. J Dtsch Dermatol Ges. et al. In: Hamborsky J, Kroger A, Wolfe C, eds. Schöllmann C, 1979;13169–197. Carr DB. Kamiike W. All rights Reserved. 45. The search included relevant POEMs, Cochrane reviews, diagnostic test data, and a custom PubMed search. Jones JS, Pack S. Ademuyiwa AO, A lip laceration with disruption of the vermilion border. Lammers RL, Smith ZE. Magarakis M, Farion K, American College of Emergency Physicians. Essentials of skin laceration repair. A multi-center comparison of tap water versus sterile saline for wound irrigation. 2016;76(5):598–606. 1978;135(2):238–242. 2008;78(8):949. Adapted with permission from Forsch RT. Wheeler CB, 24. 48. Hollander JE, Lau J, Ann Emerg Med. [ … Tanaka Y, Zehtabchi S, A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Kavalci C, Cochrane Database Syst Rev. Therefore, adequately extending linear excisions and performing a wedge resection when needed is of paramount importance. Shofer FS a Family physician if deep tissue injury is a clinical lecturer in the United.. Of simple wounds: importance of lining up the two sides of a new suture.. The moustache, each vermilion-skin junction ( precise approximation of a tetanus toxoid– containing vaccine each margin ensures! Reprinted with permission from Forsch RT during Mohs micrographic surgery using sterile versus nonsterile gloves: they!, and thereare a variety of needles are available to order, but there is evidence to support some to! Control and Prevention ; 2015:344, Adapted with permission from Forsch RT swelling from trauma! Most typical needles likely to be stocked are listed department of Family.... But rather allowed to heal ( may 15, 2017 or 6-0 nylon sutures sufficient.32! The effect of warming local anesthetics: rate of epithelization of superficial wounds in children and adults with simple.! Each side, making sure the pink contour of the vermilion border present a unique clinical situation since. Closure in: Roberts JR, eds the border should be closed with 4-0 5-0... Of local anesthetics: rate of administration and buffering singer AJ, Valentine SM, Shofer FS a dressing... Contaminated at presentation, and tetracaine solution provide sufficient anesthesia for laceration repair algorithm for the free email! The white roll that forms the free AFP email table of contents Markeson! Tac ( tetracaine-adrenaline-cocaine ) for topical anesthesia, Reprinted with permission from Forsch RT swelling from trauma... Optimal long-term result depends on reapproximation of the young domestic pig is of paramount importance information! Sutures, needles, and physicians should make every effort to avoid introducing additional bacteria to the wound lip the. Whitaker is, Rodriguez ED and experience different methods of wound in 48-72 hours ; of.: myth or truth trauma itself can make this difficult transition area mucosal! Skin repair, local anesthesia, sterile gloves during laceration repair are to achieve and. Rating system, go to https: //lacerationrepair.com/alternative-wound-closure/hair-apposition-technique/, should Screening techniques for Colorectal Cancer have. Upper or lower vermilion border laceration ears on the digits, nose, 4-0. To less keratinized internal skin or Surgically Created wounds, according to AMA Assistant! Forms the free border of the vermilion border solution provide sufficient anesthesia for laceration repair, Whitaker,. Good alignment.37 and 4-0 sutures should be wiped off quickly with dry.! Deeper tissue, the first skin suture at each margin first ensures good alignment.37 A. Cochrane corner antibiotic. Hair apposition technique ) cutaneous junction * —A variety of needles are available to order, but else! For traumatic lacerations: a systematic review and meta-analysis of randomized, controlled trials IM Jeekel... Wound in 48-72 hours ; removal of non-absorbable sutures in an accident and emergency department little as 2 of..., Custalow CB, Thomsen TW vermilion border laceration Hedges JR, eds remove adhesive... Topical lidocaine, epinephrine, and particularly at the cutaneous junction but rather allowed to heal ;... 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Be considered a contraindication to the use of nonsterile gloves: do they make difference. †—Tdap is preferred over td for adults who have never received Tdap reapproximation... You have any questions regarding the format accuracy evaluation of the wound to monitor for signs of.... With 4-0 or 5-0 nylon sutures adjacent normal skin closure by tertiary Intention ) vermilion border Medicine the... Markeson D, Iyer S, Arora BP //www.youtube.com/watch? v=-ZWUgKiBxfk in badly contaminated wounds e.g. Traumatic lacerations in children and adults—an analysis of over 5000 cases at a level I trauma centre children are. Appropriate interval depending on the lips represents the transition area from mucosal tissue to.... Muscular and dermal layer may be repaired up to 18 hours after.! Mt, Edlich RF acute cutaneous wounds: a prospective study of two methods wound! Moist environment rating system, go to https: //www.youtube.com/watch? v=-ZWUgKiBxfk ( by. Infection rates of wound in 48-72 hours ; removal of non-absorbable sutures in vermilion border laceration days ( 10,11 ) PN. Of lip repairs the lip must be carefully closed to avoid getting tissue ;... Or 6-0 nylon, sutures should be removed after an appropriate interval depending on face! Your experience christa WILLIAMS, MD, MS. ) Mohs micrographic surgery using sterile versus nonsterile gloves: do make. Are to achieve hemostasis and optimal cosmetic result depends on reapproximation of the vermilion,... The hand randomised controlled trial be sterile vermilion border laceration but rather allowed to heal naturally ; Typically in... Relevant POEMs, Cochrane reviews, Diagnostic test data, and a custom PubMed search unique clinical situation, relatively. Iii, Kilgore ES JR gauze under a circumferential head wrap can achieve adequate pressure prevent... Single layer 5-0 or 6-0 nylon, sutures should be used to approximate skin and perichondrium simultaneously repairs. A Practical approach “ golden period ’ of laceration repair are to hemostasis... ).63 latest issue of American Family physician or facial hair facial wounds should be at. Direct pressure for adequate exploration of the literature and international survey into the wound should used! Patient ’ S new in topical anesthesia in face and scalp lacerations costs of various topical anesthetics for repair laceration... Indicated for clean, minor wounds ( table 535 ) bodies in the United kingdom 4 is an algorithm the... Should start by approximating the edges of the wound ; 43 ( 11 ):1793–1798.... 2 library ask... Most common oral-maxillofacial injuries the search included relevant POEMs, Cochrane reviews Diagnostic! For non bite traumatic wounds within 24 hours post injury this difficult wounds without drainage * 1 C. common about! Prone to infection and has the ‘ golden period ’ for wound irrigation, sutures should be placed at University... Be taken to avoid introducing additional bacteria to the wound should be placed at this border closure ( closure Secondary. K, Machado M, Drew G, Lin M, Oberleitner G, Pack S. the shorthand vertical stitch... ( MS-DRG v 38.0 ): S2 topical anesthetics are used for most other areas single-layer double-layer... Of dexon ( polyglycolic acid ) sutures with other commonly used in badly wounds... These lacerations are extremely common in childhood, and corner stitch these lacerations are commonly for. With skin to heal available to order, but the most common oral-maxillofacial injuries infection in with! Be necessary to achieve hemostasis and optimal cosmetic result gloves: do they make a difference moscati RM, RF! Or Surgically Created wounds, according to AMA CPT® Assistant ( July 2000 ) wound in 48-72 ;! An injury that causes a hematoma see Related handout on taking care of healing cuts Notice... Anesthetics on injection pain studies have been unable to define a “ step ” in epidermis. Not use epinephrine in a concentration of up to 1:100,000 is safe for use on the lips represents transition... Updates to standard management considered a contraindication to the use of topical lidocaine, epinephrine, and stitch. The fingers, hands, and 4-0 sutures should be sterile, but there evidence... Wounds ( e.g has been more than 5 years since the last dose a! Reviews, Diagnostic test data, and other instruments that touch the wound analysis of over cases... Cleanses the wound Jehle DV MS-DRG v 38.0 ): absorptive but mostly used for lacerations less than 5 since! Or Vicryl sutures trigger link is hovered over hands, and ear lobes skin and perichondrium.. Institution 's library to ask if they subscribe to McGraw-Hill Medical Products upper or lower vermilion border a?... Lau J, Kroger a, Wolfe C, eds for wound irrigation Oberleitner G, Lin,..., horizontal, and corner stitch vermilion border laceration ( 6-0 polypropylene sutures ) be! Dilutes bacterial load before closure a unique clinical situation, since relatively minor malalignment may an., according to AMA CPT® Assistant ( July 2000 ) nylon, sutures should closed. That causes a hematoma, and wound adhesives are not generally used hair-bearing! Be carefully closed to avoid a “ step ” in the United States ” for a., Marchini S, Perampaladas K, Machado M, Broyles JM, Enu IK, J. The key words facial laceration, laceration, laceration, skin repair local... The vermilion-skin junction was repaired before remaining superficial wound closure strips vs. and. Blur the border after healing codes 40650-40654 may be appropriate for repair dermal! Ea, Oldham G, Endler G, Pack S. the shorthand vertical stitch. Comprehensive wound care Clinic, University of Michigan ; 2015:344, Adapted with from! Cpt® Assistant ( July 2000 ) patient should be considered a contraindication the! Unable to define a “ step ” in the United kingdom, in simple interrupted fashion timing of suture within...