Pediatric emergency medicine trisk 3400 3400

In general, lip lacerations should be closed in layers, depending on the depth of
the wound. In full-thickness lip lacerations, a three-layer repair is required. The
emergency provider should begin with the oral mucosa, using 5-0 absorbable
material, followed by the orbicularis oris muscle layer to include the inner and
outer fibrofatty layers, and finish with the skin, using 6-0 nonabsorbable or fastabsorbing gut, interrupted sutures. Small wounds, less than 2 cm, on the inner
aspect of the lip without communication to the skin surface need not be repaired.
External lip wounds not communicating with the mucosal surface can be closed
by either single- or double-layer closure, depending on the depth and degree of
gaping of the wound. Absorbable sutures (5-0) for the subcutaneous layer and
either absorbable or nonabsorbable (6-0) sutures for closure of the skin can be
used, depending on the ease with which they can be removed.
Extensive lip injuries with tissue loss or those caused by electric burns,
especially those that involve the angle of the mouth, should be referred to a
plastic surgeon. Associated injuries such as dental trauma, mandibular fractures,
and closed head injuries should be ruled out.

Cheek Lacerations
When managing lacerations involving the cheeks, the provider must evaluate the
integrity of the underlying structures. The parotid gland and duct, the facial nerve,
and the labial artery are in close proximity to the surface of the skin and can be
injured, often as a result of an animal bite. If parotid gland or duct injury is
identified, consultation with a surgical specialist is advised. Puncture wounds
resulting from animal bites should be debrided and irrigated thoroughly. Some of
these puncture wounds are better off left without closure to reduce infection rate,
especially if the cosmetic outcome is unlikely to be compromised. Otherwise,
simple interrupted 6-0 absorbable sutures can be used to close uncomplicated
lacerations of the cheeks.

Tongue Lacerations
The tongue is a vascular and muscular organ. Tongue lacerations often
hemorrhage excessively in the beginning, but the bleeding usually ceases quickly

as the lingual muscle contracts. Controversy exists surrounding the indications for
closure, which is in part related to the challenge of repair given the inaccessibility
of these wounds.
Most tongue lacerations can be left alone with good results. However, large
lacerations involving the free edge may heal with a notch causing dysfunction of
the tongue. Generally, this type of laceration should be repaired. Large flaps and
lacerations that continue to bleed or are likely to become contaminated with food