Lip surgery
Considerations:
[edit | edit source]- Loss of tissue is permanent - the lip does not readjust over time - so if a second lesion needs to be removed, often tissue replacement will be necessary
- Up to one-third of the lip can be removed by wedge resection in elderly patients and up to one-quarter in young ones.
- The defect is most noticeable from side-on, but looks fairly normal from the front, due to the flattening effect
- Wedge resections for smaller defects, and modified wedge (vermillion-muscle advancement flaps) for larger ones
Repair of lip laceration
[edit | edit source]- Mark vermillion border - needs to be aligned carefully
- Irrigate and debride wound
- Close deeper layer (orbicularis oris) with 4-0 vicryl
- Close vermillion border with 6-0
- Close inner buccal mucosa with interrupted 4-0
- Close outer skin of lip, above and below vermillion border, with interrupted 4-0
Wedge resection of lesion and primary closure
[edit | edit source]- LA +/- mental nerve block
- Mark lesion with 2-3mm margin. Cross vermilion-cutaneous border at right angles. Taper the cutaneous closure to a point that is likely to prevent dog ears. Don't cross the mento-labial crease (follow the curve, if you have to extend the excision that far). In the upper lip, can follow the alar groove if necessary. The internal mucosal wedge is usually smaller.
- Excise a clean, full-thickness wedge
- Identify the labial arteries and either diathermy or ligate
- To temporise bleeding and aid in identification of bleed points, compress the lip laterally between thumb and index finger on each side
- Close dead space of muscular layer with 4-0 vicryl
- Appose vermillion border with 6-0 - use colour change, hair-bearing skin, texture to help identify the specific point.
- Close buccal mucosa
- Close skin