jwells78 Posted September 9, 2010 Share Posted September 9, 2010 Ok, so I had a 15 y/o dog bite to face involving the Rt. external upper lip and a nice 3 cm, deep/gaping laceration to the inside of the same lip; NOT through and through. Cleansed/ Tdap, ect. Infraorbital nerve block for anesthesia. External closure went well with 6-0 nylon, small needle; approximated the vermillion well. Then came the pain in the butt. Closure of the inside of the lip encountered these problems: -difficulty maintaining visualization; ended up putting the forceps down and using my left hand to hold the damn lip back -approximation; though I knew it would be loose, esp. since inside the mouth/ dog bite -suture throws grabbing surrounding tissue while tying Took me a LOT longer to finish than I expected and it was relatively difficult. Does anyone have any tips for suturing large inner lip lacerations? -J Link to comment Share on other sites More sharing options...
rcdavis Posted September 9, 2010 Share Posted September 9, 2010 have a cna put on some gloves and evert the upper/lower lip as you sew. no prob. Link to comment Share on other sites More sharing options...
jwells78 Posted September 9, 2010 Author Share Posted September 9, 2010 could have used an extra set of hands- how come I didn't think of that? If I could only find a tech... -J Link to comment Share on other sites More sharing options...
mytopeka Posted September 10, 2010 Share Posted September 10, 2010 I usually close the inner lip first. If you do the outside first, you stress the heck out of the fine suture that you just threw on the outside when you (or the tech, or the cna) pull the lip back. Link to comment Share on other sites More sharing options...
slolar Posted September 10, 2010 Share Posted September 10, 2010 I also can never find a tech/cna etc to help me. I have been known to ask the pt to reach up and hold the lip down for me. I agree with doing the inner lip first. Just loosely approximate. You don't want food etc getting stuck in it. If smaller than a kernal of corn, I often won't even suture it. The mucosa heals really fast. Link to comment Share on other sites More sharing options...
ezetimibe Posted October 8, 2010 Share Posted October 8, 2010 You needed and assistant. Running-interlocked sutures on the inside of the mouth. Link to comment Share on other sites More sharing options...
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