2007;8(4):232–239. 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. Use a skin marker to outline the the vermillion border on each side, making this easier. 22. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. Gennis P, Edilich RF. A randomized controlled trial of buffered lidocaine for local anesthetic infiltration in children and adults with simple lacerations. 1. 0000003624 00000 n . Cartilage has poor circulation and is prone to infection and necrosis. Rui-feng C, iM�P�ǝ���jx�����-8��iF �b/��r@����ؑ�?�Hs}.��ؓ>^��r*zoQȡ�[�K������ALa�` m)3� endstream endobj 1029 0 obj <>/Filter/FlateDecode/Index[80 876]/Length 49/Size 956/Type/XRef/W[1 1 1]>>stream You may use these HTML tags and attributes: Save my name and email in this browser for the next time I comment. Diagnosis and treatment of retained foreign bodies in the hand. Sayhan MB. H�\�݊�@��}����4ZU=�$3���a�� F;Ya��1y���fa��#Z~+��w���]�=��!���]�������٪t]��W�{i�,OÇ�u��p��v��t�:ǻ{�t�1. Don't miss a single issue. Wound Closure Manual. A comparison of dexon (polyglycolic acid) sutures with other commonly used sutures in an accident and emergency department. 18(3):101-2. Using potable tap water instead of sterile saline for wound irrigation does not increase the risk of infection. Debridement: an essential component of traumatic wound care. [Medline]. [25]. 0000003294 00000 n 2005;2(3):272–281. Required fields are marked *. Extraoral approach to close the deep layer. Oberleitner G, Laceration Repair Round Up: Best Posts for Learning to Suture. Hedbloom EC. Gallagher EJ. New York, NY: Thieme, 2008. Be aware that the layers of the lip (see figure below) must be well Reprinted with permission from Forsch RT. Georgoulis AD. Smith J, Maconochie I. An optimal cosmetic result depends on reapproximation of the vermilion border. Slieker JC, Magee CM, Perelman VS, Gracely EJ. If you can’t locate a surgical marker, you can use the method for lining up the vermilion border outlined. If you suspect a possible facial fracture, order appropriate imaging. Vance CW, Hashemi K, Here is an interesting discussion on Plastic Surgery Key, Your email address will not be published / Required fields are marked *. Zawora MQ, Whitaker IS, Primary closure versus non-closure of dog bite wounds. Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical AssociatesDisclosure: Nothing to disclose. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. *University of Rochester School of Medicine and Dentistry Rochester, NY Lacerations of the lip are a common injury seen in a pediatrician’s office. This is based on expert opinion and experience. 194018-overview Does the choice of suture material affect the incidence of wound infection? Clinical Procedures in Emergency Medicine. 2014;90(4):239–243. Journal Article, 2001 Lucchesi M. 0000019678 00000 n Copious irrigation is the name of the game in preparing most traumatic wounds. Nabili V, Knott PD. Further inspection of the anesthetized wound reveals a through-and-through laceration. 34. Dubinisky I, Komolafe EO, 123-128 Chap 7. %PDF-1.5 %���� Important considerations include timing of the repair, wound irrigation techniques, providing a clean field for repair to minimize contamination, and appropriate use of anesthesia. / Vol. About one-third of foreign bodies may be missed on initial inspection.6. 0000045095 00000 n An optimal cosmetic result depends on reapproximation of the vermilion border. 0000027692 00000 n J Pediatr. 0000006498 00000 n * The approximation of the vermilion-cutaneous junction is the most crucial step in the closure of lip lacerations that involve the vermilion border. 2004;20(8):519–524. Makris EA, Clinical policy for the initial approach to patients presenting with penetrating extremity trauma. 0000001796 00000 n 0000028726 00000 n All rights Reserved. vanderVaart S, Lau J, a randomised controlled trial. Management of bite wounds in children and adults—an analysis of over 5000 cases at a level I trauma centre. 2007 Feb. 25(1):83-99. Saconato H. Cho S, Cochrane Database Syst Rev. Surg Gynecol Obstet. 47. 0000030513 00000 n Plast Reconstr Surg. †—Tdap is preferred over Td for adults who have never received Tdap. Adeolu AA, Upper lacerations closed with a total of 3 5-0 nylon sutures, vermilion border was approximated first in both cases. Shermock KM, Li-song H, Water for wound cleansing. Greenway HT, 0000010343 00000 n Gretchen S Lent, MD Attending Physician, Department of Emergency Medicine, Torrance Memorial Medical CenterDisclosure: Nothing to disclose. Zawora MQ, 1999;17(2):223–228. Injuries that require subspecialist consultation include open fractures, tendon or muscle lacerations of the hand, nerve injuries that impair function, lacerations of the salivary duct or canaliculus, lacerations of the eyes or eyelids that are deeper than the subcutaneous layer, injuries requiring sedation for repair, or other injuries requiring treatment beyond the knowledge or skill of the physician. Injecting lidocaine or swelling from the trauma itself can make this difficult. and What are potential complications of a complex lip laceration? 0000034298 00000 n Mitigating the Opioid Crisis for Wound Care Providers Using Opioid Stewardship. 1994;24(1):36–40. This website also contains material copyrighted by 3rd parties. 0000011904 00000 n Lip Reconstruction. Lip laceration involving the lower vermilion border. Use of clean nonsterile examination gloves, rather than sterile gloves, during wound repair has little to no impact on rate of subsequent wound infection. Hemostasis controls bleeding, prevents hematoma formation, and allows for deeper inspection of the wound.3 The next step is to determine whether vessels, tendons, nerves, joints, muscles, or bones are damaged. 0000025335 00000 n Adler AJ, RANDALL T. FORSCH, MD, MPH, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School in Ann Arbor.... SAHOKO H. LITTLE, MD, PhD, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School. Magarakis M, The first suture you place in lacerations crossing the vermilion border should go directly in this area to obtain proper laceration alignment. Jasani M, Edlich RF. 2002 After ruling out intracranial injury, bleeding should be controlled with direct pressure for adequate exploration of the wound.

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