Lip lacerations - lacerations of the lip must have the
vermilion border approximated exactly.
Lacerations involving the muscle layers or through-and-through lip
lacerations require approximation of each layer (muscle to muscle,
mucosa to mucosa and skin to skin).
Intraoral lacerations - minor mucosal breaks require
no suturing, and mouthwashes should be suggested. Larger tears should
with absorbable, preferably mattress sutures.
Through-and-through facial lacerations - intraoral mucosa,
muscular layer and skin surface must all be approximated. Failure
the muscular layer, which may be retracted, can later result
in a depression of the scar.
Facial nerves or parotid duct injuries
should not be overlooked.
The facial nerve is motor and in five main branches (temple, xygomatic,
bucal, mandibular, cervical).
The parotid duct is found on a line between the tragus of the ear
and the angle of the mouth. Drooping of the upper lip, for example,
would signify division of the buccal nerve branch. This is often
accompanied by parotid duct injury.
middle third of a line from the targus to the middle of the upper
lip indicates the general course of the parotid duct.
Ear lacerations - conservative debridement should be the
rule. Good skin closure over cartilage is needed to avoid chondritis.
Take the skin and perichondrium in a single bite using a removable
suture material. Use many sutures to contour the tissue to the normal
Anticipate hematoma formation if there is significant
use a pressure dressing. A cauliflower deformity will be prevented
Eyelid lacerations - it is best to refer to Ophthalmology
all eyelid lacerations other than minor surface ones. Beware
of associated ocular or nasal lacrimal duct injury. Layer by layer
tarsus, skin) must be done.
Lid margin lacerations require repair with eversion to prevent
Eyebrow lacerations are usually easily repaired with
simple sutures. Eyebrows should not be shaved.
Nailbed injuries - if there is significant subungual hematoma
then suspect a nail bed disruption and/or a distal phalangeal fracture.
The nail bed, if lacerated, should be repaired with absorbable sutures
to prevent nail deformity in the future. An intact nail can be glued
or sutured back in proper position to act as a splint and for protection
of the nailbed.