Article Text

Should we glue lip lacerations in children?
  1. Jason Smith1,
  2. Ian Maconochie2
  1. 1Specialist Registrar in Emergency Medicine, Defence Medical Services
  2. 2Consultant in Paediatric Emergency Medicine, St Mary’s Hospital, London, UK

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A 7 year old boy presents to the emergency department having fallen in the playground, sustaining a laceration to his bottom lip which crosses the vermilion border. You know that the potential uses of tissue adhesive in the paediatric population are increasing, and wonder if it may be used in these circumstances instead of the traditional method of formal suturing.

Structured clinical question

In children who have sustained a lip laceration extending through the vermilion border [patient], is tissue adhesive [intervention] better than sutures [comparison] at reducing procedural discomfort and improving cosmetic outcome [outcomes]?

Search strategy and outcome

Medline 1966 to August 2002 using the Ovid interface (exp lacerations or exp wounds, nonpenetrating or exp facial injuries or laceration$.mp or exp wounds and injuries or wound$.mp) and (exp lip or lip$.mp or vermilion$.mp) and (exp fibrin tissue adhesive or exp tissue adhesives or tissue adhesive$.mp or $cyanoacrylate$.mp or exp cyanoacrylates or wound glue$.mp or or exp wound healing or exp suture techniques) limit to human and English.

Altogether 292 papers were found, of which only one described the proposed intervention.1 Three other papers were found comparing tissue adhesive to sutures in paediatric patients with facial lacerations, and these have also been included in table 1.

Table 1

Should we glue lip lacerations in children?


Traditional teaching has been that in lacerations involving the lip, the vermilion border must be accurately approximated with a suture to ensure that healing occurs without a step. A recent systematic review2 has outlined the benefits of using tissue adhesive as an alternative method of wound closure to sutures, and three studies have specifically looked at a comparison between tissue adhesive and sutures in paediatric facial lacerations.3–,5 These all compared tissue adhesive to sutures, and gave comparable cosmetic results with less time taken for the procedure and less pain for the child with tissue adhesive. However, lacerations of the lip were excluded from these trials. Although it is tempting to extrapolate these findings to other specific areas of wound management such as closure of lip lacerations, problems associated with this location could be anticipated, such as the child biting or licking off the glue. It should be borne in mind that there is a small but statistically significant increased rate of dehiscence with tissue adhesives compared to sutures.2 There is only one published case report supporting tissue adhesive as a method of closure in these lacerations.


  • Pending further studies looking specifically at this problem, local advice should be followed.


Supplementary materials




    Table 1 Should we glue lip lacerations in children?

    CitationStudy groupStudy type (level of evidence)OutcomeKey resultsWeaknesses

    de Blanco (1994)A 10 year old boy and a 46 year old woman, both with lip lacerationsCase report (level 4)Cosmesis at 18 days and 1 yearWound closed with only slight scarSimple case report, no comparison with standard, one of the patients adult
    Quinn et al (1993)81 paediatric patients with clean facial lacerations, randomised to glue or suturesPRCT (level 1b)Cosmetic score at 3 months, procedural pain, time taken for procedureNo difference in cosmesis, glue faster and less painful than suturesLip lacerations excluded
    Bruns et al (1996)61 paediatric patients with facial and scalp lacerations, randomised to glue or suturesPRCT (level 1b)Cosmetic score at 2 months, procedural pain (perceived by parents), time taken for procedureNo difference in cosmetic outcome, glue faster and less painful than sutures. Parents more likely to recommend glue to othersLip lacerations excluded
    Barnett et al (1998)163 paediatric patients with non-ragged lacerations, randomised to glue or suturesPRCT (level 1b)Cosmetic score at 3 and 12 months, procedural pain (perceived by parents, doctors, nurses, and children), time taken for procedureGlue faster and less painful than sutures (scored by all except the child). No difference in cosmesis at 3 or 12 monthsLacerations to all body parts included except eyes and mucous membranes


  • Bob Phillips