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Provider Prepared's Weekly Pearl of Wound Wisdom #29 Lip Smacking Good!

Provider Prepared's Weekly Pearl of Wound Wisdom #29 Lip Smacking Good! 0

   Lip anatomy consists of the mucosal surface within the mouth, the middle orbicularis oris muscle, the wet vermillion (intraoral) and the dry vermillion (extraoral). These anatomical layers make the lip a very unique structure that requires special attention for wound management. The outline of the lip where vermillion meets the facial skin is called the vermillion border. The vermillion border is a point of cosmetic light reflection, this necessitates precise alignment to prevent a noticeable scar.

   When the vermillion border is involved in a lip laceration, the first stitch should placed at the vermillion border, achieving perfect cosmetic alignment of the border. Nonabsorbable 5-0 or 6-0 suture should be used. 

   Superficial wet vermillion lacerations that are not gaping, less than 2 cm and without oozing of blood do not require repair. Wounds that are gaping, with bleeding and greater than 2 cm do require repair. This repair should be completed with buried absorbable 5-0 or 6-0 suture.

   Lacerations of the dry vermillion should be closed similarly with simple interrupted sutures, when the wound extends into submucosal tissue with no vermillion border involvement.

Hollander, JU et al. Assessment and management of lip lacerations. UpToDate November 2017.

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Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #28 Tongue Lashing

Provider Prepared’s Weekly Pearl of Wound Wisdom #28 Tongue Lashing 0

A 3 year old male is brought to the emergency department for repair of a tongue laceration. As he was playing with older siblings, he fell forward striking his chin on the floor causing him to bite his tongue. He suffered a laceration across the full width of his anterior tongue, that is gaping with on going active bleeding.


Repair of tongue lacerations should be considered when the laceration is greater than one centimeter, extends into muscular layers or that are full thickness. Additionally repair should be considered when the lateral border of the tongue is involved, if large gaping of the wound is present, or flaps are created by the wound.

Tongue wounds that are less than one centimeter and non-gaping, without previously mentioned anatomical involvement, typically do not need repair.
When repair is indicated, absorbable suture material that is 3-0 or 4-0 should be used.
Jasper, JI et al. Evaluation and repair of tongue lacerations. UpToDate June 2017.

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Provider Prepared

Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #27 Soccer cleat to the ear!

Provider Prepared’s Weekly Pearl of Wound Wisdom #27 Soccer cleat to the ear! 0

A 20-year-old male presents to the emergency department with extensive wound to his left ear which occurred while playing an aggressive soccer game.  Another player's soccer cleat became caught in the patient's ear gauge creating extensive auricular injury.

Complex auricular lacerations are those that expose the cartilage or extend through the cartilage. These wounds require very careful and detailed closure. In general, sutures should not be passed through the cartilage itself. In order prevent notching or a step-deformity, the perichondrium must be reapproximated. The cartilage must also be covered with skin for appropriate cosmetic repair.

The skin of the ear is so thin and firmly adhered to the perichondrium, stitches that simultaneously reapproximate both layers are acceptable. The perichondrial layer should be the deepest layer of sutured tissue.If absorbable suture is used, it should not be dyed material to avoid tattooing of the repaired tissue.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016

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Provider Prepared

Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #26 Lend me your Ear

Provider Prepared’s Weekly Pearl of Wound Wisdom #26 Lend me your Ear 0

A 40 year old female presents to the emergency department with a superficial laceration to the upper part of her right ear.  This laceration was created as she was struck by a tree branch while doing yard work at her home this afternoon.

Simple lacerations of the ear are those that spare the cartilage. The most common location for a simple laceration of the ear is the ear lobe. These are appropriately closed with 6-0 nonabsorbable suture.

A 6-0 absorbable suture is reasonable to use in young children and in patients without certain follow up for suture removal. Most experts recommend fast-absorbing gut, as the absorbable suture material.

Auricular anesthesia can be obtained with local injection of Lidocaine without epinephrine, or by regional auricular block using Lidocaine with epinephrine.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016.

This patient's laceration did not have involvement of the cartilage, it was easily repaired with 6-0 prolene in a simple interrupted fashion.

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Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared's Weekly Pearl of Wound Wisdom #25 To air or not to air?

Provider Prepared's Weekly Pearl of Wound Wisdom #25 To air or not to air? 0

After excellent closure of a scalp wound, those closed with staples or nonabsorbable sutures can be left open to air. After 24-48 hours, they should be gently cleansed with soap and water. 

Wounds that are small and superficial, requiring only a few staples or sutures for closure, can have suture or staple removal in 7-10 days. Larger more complex wounds should be considered for suture or staple removal after 10-14 days.

Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.

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Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #24 Gashing Galea!

Provider Prepared’s Weekly Pearl of Wound Wisdom #24 Gashing Galea! 0

A 32-year-old male presents to the emergency department with a laceration to the forehead extending up into the hairline. This occurred after a cut off wheel on a 7 inch grinder flew apart, and a portion of the cut off wheel impacted him in the head creating this laceration.

Assessment of scalp lacerations should also include assessment of all of the deep tissues. The galea is the connective tissue layer against the bone. This needs to be assessed to determine if there is presence of a galeal laceration. Lacerations of the galea larger than 0.5 cm should be repaired. Literature recommends using 3-0 or 4-0 absorbable suture material in the galea.

Repair of the galea helps prevent development of subgaleal infections, and subgaleal hematoma. Repairing galea lacerations also protects anchoring of the frontalis muscle, which has cosmetic implications.
Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.

This patient’s wound did involve the galea. A complex three layer repair was performed with excellent cosmetic outcome.

Visit here: Provider Prepared to see your options to be affordably and honestly prepared for all your wound care needs at home and on the go!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee