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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
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]

Search Outcome

After screening of the abstracts an reading of the articles: 3 articles relevant to question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Luck RP, Flood R, et al. March 2008 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
Al-Abdullah T, Plint AC, et al. May 2007 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
Evans R, Jones J. January 2006 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

Comment(s)

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)

Clinical 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. Pediatric Emergency Care 2008 Mar; 24(3):137-42.
2. Al-Abdullah T, Plint AC, et al. Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis. Pediatric Emergency Care 2007 May; 23(5):339-44
3. Evans R, Jones J. Best evidence topic report. Absorbable sutures in paediatric lacerations. Emergency Medicine Journal 2006 Jan; 23(1):64-5.