Anatomically, the vermilion border of the lips represents the transition area from mucosal tissue to skin. Lip lacerations involving the vermilion border present a unique clinical situation, since relatively minor malalignment may produce an unacceptable cosmetic result. An associated underlying gingival or dental injury is a common finding.
Management and Disposition
Accurate vermilion margin reapproximation is the 1st goal of lip repairs. An unapproximated vermilion margin of 2 mm or greater results in a cosmetic deformity. A regional block of the mental or infraorbital nerve is recommended for anesthesia to avoid additional tissue edema and anatomic distortion produced by local infiltration. Deep or through-and-through lacerations involving the vermilion border should be closed in layers. After closure of the deeper tissue, the 1st skin suture is always placed at the vermilion border to reestablish the anatomic margin. Using 5-0 or 6-0 nylon, sutures should be placed along the vermilion surface until the moist mucous membrane is encountered. The deep muscular and dermal layer may be closed with 4-0 chromic or Vicryl sutures. Mucosal layers are loosely reapproximated with absorbable suture. Update the patient’s tetanus status prior to discharge. The patient should be given wound care instructions and follow-up for wound evaluation and possible suture removal within 3 to 7 days.
Vermilion Border Lip Laceration. A lip laceration with disruption of the vermilion border. Wound repair begins at the vermilion-skin junction (precise approximation of A to B in this case) for a good cosmetic result. (Photo contributor: Kevin J. Knoop, MD, MS.)
A vermilion border with as little as 2 mm of malalignment may produce a cosmetic defect.
Always carefully place the first skin suture at the vermilion border in any lip laceration.
Complex Vermilion Border Lip Lacerations. This patient suffered vermilion border lacerations in two areas from an assault with a broken bottle. Following shaving of the moustache, each vermilion-skin junction was repaired before remaining superficial wound closure was achieved. (Photo contributor: R. Jason Thurman, MD.)