Today’s news was marked by the traumatic injury to President Obama while playing a pickup game of basketball. He was inadvertently elbowed in the mouth, resulting in a lip laceration. This type of sports injury, particularly in basketball, is not uncommon. The force of the elbow presses the lip against the solid bumper behind it known as the teeth. Between the elbow and the teeth, the lip has little chance being the less stout of the three. A laceration invariably results, splitting the pink vermilion on the outer lip. The lip laceration will usually extend inward on the inside of the lip because the mucosa of the lip lining is quite soft. The laceration may also cross the border of the vermilion outward onto the visible skin next to the lip.
While unfortunate, President Obama will go on and heal uneventfully. The lip will be swollen for a week or so but the lip will mend itself. What interested me most about this story, however, is what his press secretary said afterward. He described the lip repair as being done with ‘small monofilaments which took longer to do but will heal with less scar’, to paraphrase his comments.
He no doubt was specifically talking about the use of fine small sutures to meticulously put the lip back together. But what is a monofilament suture and why was it used? Monofilament sutures are made from a single strand of non-resorbable plastic material. This makes for a smooth slick strand of material of very small size. (calling it a thread would be inaccurate since a thread is a braided strand which is not a smooth surface) The benefits of a monofilament suture comes from this smooth surface. This makes it easier to pass the suture through the tissues with less trauma. Its smooth surface also makes it more resistant to harboring microorganisms and cause wound infection since there are no nucks and crannies for the bacteria to get into and multiply. The surface is simply too smooth. This smooth surface also makes them easier to remove as they slide out better.
Monofilament sutures are commonly used in plastic surgery of the face, whether it be laceration repair or for closure of elective incisions. The size of a suture is given in O sizes and is reflective of its thickness. In the face, small sizes of 5-0 (.1mm in diameter) or 6-0 (.07mms in diameter) monofilament sutures are used. Because of this small size, it is understandable why they must be more meticulously placed and take longer to do. These very small sutures can be left in a little longer than a week if necessary as the potential to leave visible tracks (holes were the sutures originally were) is not significant with such small diameter sutures.
The President’s monofilament lip sutures will likely be removed in 7 to 10 days. Will this injury leave him with a visible scar? There is no way to know for sure right now but the use of small monofilament sutures gives him the best chance to have an optimal outcome from his injury.
Dr. Barry Eppley
Indianapolis Indiana