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Primary Surgery Vol.2 – Trauma |  |
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Primary Surgery Vol.2 – Trauma | |
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Tears of a patient’s lips are often caused by his teeth. If a piece of tooth is missing, feel for it inside his lip. Small tears on the inner surfaces of his lips don’t need suturing. Suture larger lacerations in layers. Close his mucosa as a separate layer. If a laceration crosses his skin–vermilion border, mark it with a felt pen before you inject the local anaesthetic because the anaesthetic will blanch it and make accurate alignment difficult. Use the first fine monofilament stitch to draw his skin–vermilion border together, as in D, and E, Fig. 61-4. Traction on this will cause the other structures to fall into line. If a laceration involves his labial sulcus, put your second suture into this, so as to align it. If you don’t, it may be obliterated later. If his orbicularis oris muscle is divided, suture it first with 3/0 catgut. Then bring his skin-vermilion border together. Finally, suture his mucosa with fine catgut. CAUTION! Preserve the line of his skin–vermilion border. If up to one quarter of his lip is missing, you can repair it by primary suture without great deformity. If so much of his lip is missing that you cannot close it by primary repair, suture skin to mucous membrane, as in B Fig. 61-4, and apply a vaseline gauze pack held by adhesive strapping. Refer him.
If a laceration of a patient’s gum retracts and exposes the margin of his alveolus, suture it. Dressings are not required. Remove skin sutures on day 4, and sutures in the mucous membrane on day 8.
If a laceration does not involve the edge of a patient’s tongue, or leave a free flap, you may not need to do anything to it. Otherwise, suture it with catgut. If it is on the tip. suture it using ketamine and suction, or use local anaesthesia. If it is on the dorsum, he may need a general anaesthetic with nasotracheal intubation (A 13.4). Children may need a general anaesthetic.
If the anterior two thirds of an injured tongue bleeds, hold it in a piece of gauze and pinch it between your finger and thumb behind the tear. Put in a mouth gag and repair it with fine silk. If deeper sutures are needed, use catgut.
If the tip of a patient’s tongue is almost completely avulsed, try to repair it. It will probably live.
If the posterior third of his tongue is bleeding, put your index finger over it, and press it down against his mandible.
If you cannot reach a severe tongue wound, do a tracheostomy under local anaesthesia. Pack the patient’s pharynx and repair his wound with deep stitches.
Repair these with catgut.
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Primary Surgery Vol.2 – Trauma | |
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