I had submitted a question about a month ago regarding my 3 1/2 year old son's lip scar. I wanted to follow up as it has now been 2 months since his laceration occured and I do not see any significant changes so far. He was struck with a hotwheel which split his upper lip, vertically, across the vermilion border and the skin above it. It is right on the phitral column. The laceration was about 1 cm long and "subcutatneous" The ER doctor put only one suture in his lip and not on the vermilion border. I am concerned because for one, I cannot tell if the border was lined up properly because the scar is somewhat thick ( about 1 mm), especially on the area above his lip. I believe this is because they didn't stitch that area because apparently it "wasn't deep enough" to be stitched, so it was left to heal on it's own, and the edges were not brought together and maybe also because of tension due to the location. Secondly, I am concerned about the indentation of the scar. Since there was only one stitch, the wound edges were not at all everted, or even closely approximated (except in the spot where the one suture was, which was in his actual lip) and not where it was split above the lip. In your opinion, is it possible that this indented scar could fill in? I know it has only been two months, but based on the method of repair as well as the location of the laceration, I am concerned that due to the edges not being brought together as well as tension on the wound from eating/talking/crying etc, could cause this to stay indented. Also, I would like to add that he got really sick about a week and a half after the injury with really high fevers, (104-106) and then a few days later after recovering from that had strep throat and another viral infection combined...so he was sick for almost 3 weeks shortly after this injury and was not eating well. Could this have also contributed to the healing process? I really appreciate your input.
First, its impossible to comment about the lip scar based just on your description. A direct examination would be imperative. Second, at 2 months post injury, the healing wound is far from mature. Any consideration of scar revision should not be addressed until full maturation has occurred (estimated to be at least one year from the date of injury). Third, it is unlikely that any plastic surgeon would consider a scar revision in a 4 year old. The child would be indifferent about the condition of the scar, and any revision would require a general anesthetic. In addition, in this phase of rapid growth, healing of a revised scar may not be optimal (it potentially could overheal and become hypertrophic).
It is impossible to say if the infection following the injury contributed to its current condition, unless the wound itself was actually infected.
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