Lip lacerations: absorbable nversus non-absorbable sutures? n

Date First Published:
June 17, 2009
Last Updated:
June 17, 2009
Report by:
Griet MZS Spiessens, M.D., 2nd year Resident in Emergency Medicine (Reinier de Graaf Groep Delft)
Search checked by:
Griet MZS Spiessens, Reinier de Graaf Groep Delft
Three-Part Question:
In [patients with lip lacerations, adults as well as children,] does the [use of absorbable sutures] provide a [better cosmetic outcome and less complications] versus the use of non-absorbable sutures?
Clinical Scenario:
A 21 year old lady present to your Emergency Department with a laceration of the upper lip after accidentally being hit the by the tennis racket of het co-player. You wonder what kind of sutures provides the best result but nobody in your department really knows for sure, and the plastic surgeon can not be contacted.
Search Strategy:
Pubmed, Cochrane, BestBet
Search Details:
Pubmed:
MesH terms: [lacerations] AND [lip] AND [sutures]
Search terms: [lacerations] AND [lip] AND [sutures]AND/OR [absorbable]
LIMITS: Humans/CCJ/CT, Meta, Practice Guidelines, RCT, Review

Further search through 'related articles'

Cochrane:
Search term: [laceration]

BestBet:
Search term: [laceration]
Outcome:
After screening of the abstracts an reading of the articles: 3 articles relevant to question
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Luck RP, Flood R, et al. Mar-08 USA Patients between 1-18y, presenting with linear isolated facial lacerations, 1-5cm in length, receiving 1- or 2-layered suture reapair
 Randomized controlled trial Long-term cosmetic outcomes No significant difference Loss to follow-up 46%
Complication rates No significant difference
Parental satisfaction No significant difference
Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis. Al-Abdullah T, Plint AC, et al. May-07 Saudi-Arabia Patients with traumatic laceratons and surgical wounds Systematic review of RCTs Cosmetic outcomes and complications No statistically significant difference between absorbable and nonabsorbable sutures in short- or long-term cosmetic score, scar hypertrophy, infection rate, wound dehiscence, and wound redness/swelling A lack of large, methodologically sound RCTs
Best evidence topic report. Absorbable sutures in paediatric lacerations. Evans R, Jones J. Jan-06 USA Paediatric patients with traumatic lacerations
 Short cut review Short term cosmesis No statistically significant differences Only 1 relevant study
In that study 34% loss to follow-up
Wound dehiscensce No statistically significant differences
Cosmesis at 4 months No statistically significant differences
Author Commentary:
In patients with lip lacerations, non-absorbable sutures seem to be no better than absorbable sutures concerning cosmetic outcome and complications. Especially in children, there is the benefit of avoiding the emotional and physical
trauma and cost of suture removal.
Level of Recommendation: A (consistent level 1 studies)
Bottom Line:
In patients with lip lacerations, it is advisable to use absorbable sutures.
References:
  1. Luck RP, Flood R, et al.. Cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations.
  2. Al-Abdullah T, Plint AC, et al.. Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis.
  3. Evans R, Jones J.. Best evidence topic report. Absorbable sutures in paediatric lacerations.