Skill Checkup: Complex Lip Laceration

Richard H. Sinert, DO

Disclosures

October 11, 2019

Certain wounds, such as the following, are best closed in consultation with a plastic surgeon:

  • Large flaps

  • Large areas of missing vermilion border

  • Macerated wounds

  • Involvement of the commissure

  • Loss of more than 25% of the lip

The use of prophylactic antibiotics in lip lacerations is controversial. Many textbooks recommend the use of prophylactic antibiotics for through-and-through and intraoral lip lacerations, but evidence is not definitive. If indicated, medications used for prophylaxis vary depending on clinician preference and range from oral cephalexin to chlorhexidine rinse. The risk of contamination is considerable in intraoral lacerations, but the risk of resulting infection is low due to excellent vascularity. However, with highly contaminated wounds, the administration of prophylactic antibiotics should be considered, depending on the depth and degree of contamination.

In small or uncooperative children, procedural sedation is highly recommended because of the importance of an immobile field.

Remove nonabsorbable sutures that are visible on the external tissue in 4-5 days to prevent scarring.

This Skill Checkup was excerpted and adapted from the Medscape Drugs & Diseases article Complex Lip Laceration

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