"Pearls" for suturing intra-oral lacs?

[DogLovingPA]

Not something we see often in UC (most are so minor they don't need suturing or they are at the other end of the spectrum and I send them to the ER).  Had a guy yesterday with a lac inside his right lower lip that definitely needed a stitch or 4 but didn't need ER/Specialty care.  My suturing technique is pretty good overall but this was only my second intra-oral lac.  It went OK and he'll heal just fine - but was wondering if any of you that have been doing this much longer have any pearls?   Ie. tips for folding/holding the lip out without distracting edges of wound, tips for hemostasis, tips for general wound closure given that these are usually a jagged mess from a blunt MOI.....??

 

Thanks!

[jen0508]

IMO, what helps the most is minimizing the amount of injected local anesthesia, since it can distort the wound. infraorbital blocks are awesome for the upper lip. I have had good success with topical anesthetics like LET (sock cotton swab and have pt hold on the wound for 15-20mins) even hurricane gel works pretty well...ive been able to suture people using the gel alone, if they arent numb then it definitely minimizes the amount of injected anesthesia. Using small needle like insulin needle helps too. If its in an ackward spot, having a tech (or pt themself) hold the lip in the right position. From my experience though, the most important part of lip wounds is the vermillion border and the adjacent skin....mucosa doesnt matter...my mentor always told me if you put 2 edges of mucosa together in the same room they will come together just fine :)

[medic25]

Agree with above. We stock 20% benzocaine gel for intraoral topical anesthesia which works well. One thing I've found to be very useful is a headlamp. Visibility can be tough inside the mouth, but with a simple headlight from Home Depot (if you don't have a fancier one) you'll have a much better view of what you're sewing.

[sk732]

I do regional or dental blocks to minimize distortion - and do topical prior to the dental block..  Head lamps are great - they're dirt cheap and a God send for some things, not just wounds in the mouth.  Don't do what dentists do and talk to the person expecting a response while you're up to your elbows in someone's mouth - just rude and things get in the way.  A little atropine, scopolamine or glycopyrrolate  prior if you're going to be awhile helps keep the mouth dry for you.

 

SK

[GetMeOuttaThisMess]

Haven't seen the obvious answer yet. Bury the knot.

[ohiovolffemtp]

Rapid absorbing gut suture - 6-0.  It's a little tough to work with because it's about like sewing with a blonde hair, but dissolves & doesn't require suture removal.  Advise the patient to avoid spicy, salty, acidic, and crunchy foods for 3-5 days.  I often have the patient hold their own lips in the proper position.

[DogLovingPA]

Thanks for the tips!   I did use FA gut 6-0 which was oh so fun ;-)  I also have a headlamp, perhaps I'll start toting this to work with me.  This lac was all mucosal so I was pretty sure it would all heal fine even with me bumbling through it.  I did local anesthesia but will definitely consider topical +/- regional/block next time.