Beyond Sutures: Moist Exposed Burn Ointment (MEBO) and Scar Massage for Anatomical Restoration of Penetrating Upper Lip Laceration at the Vermilion-Cutaneous Junction in Primary Care-A Case Report

Abstract

Introduction: Workplace-related traumatic lip injuries, particularly at the vermilion-cutaneous junction, are challenging due to functional impairment and visible scarring. While typically managed in specialized settings, some cases present in primary care clinics. This report details the successful management of a penetrating laceration at this junction using layered closure and MEBO for optimized healing, with postoperative scar massage therapy to enhance recovery.

Case presentation: A 19-year-old male construction worker sustained a full-thickness laceration from the vermilion-cutaneous junction to the inner mucosa. The injury was repaired in a primary care clinic, where precise vermilion alignment was essential. Layered closure was performed using absorbable (5-0 Vicryl) sutures for mucosal, muscular, and dermal layers, and nonabsorbable (6-0 Prolene) sutures for the vermilion-cutaneous junction. MEBO, a plant-based ointment primarily used for burns, was applied postoperatively to promote healing, and reduce scarring. Scar massage therapy was initiated after wound healing. Follow-ups at 5 days, 1 week, 6 weeks, and 4 months showed excellent cosmetic outcomes, minimal scarring, and full functional recovery.

Clinical discussion: 6-0 Prolene was preferred over nylon sutures due to its superior biocompatibility. Simple interrupted sutures ensured tension-free closure for optimal healing. MEBO supported epithelial proliferation, moisture retention, and reduced inflammation-promoting faster tissue repair and superior scar remodeling compared to standard antibiotic ointments, petroleum jelly, or silicone gels. Postoperative scar massage further enhanced collagen remodeling, reduced fibrosis, and improved lip flexibility.

Conclusion: This case highlights the feasibility of managing complex lip injuries in a primary care setting and emphasizes the importance of precise anatomical repair, proper suture selection, and novel interventions like MEBO and scar massage. Further research is needed to establish MEBO's role in standard postoperative care for traumatic lip injuries.

Keywords: MEBO therapy; case report; cosmetic outcome; full-thickness lip laceration; lip repair; lip trauma; primary care; scar massage; suturing technique; vermilion-cutaneous junction repair; wound tension.

Figure 1.

The initial injury to the upper lip shows a penetrating full-thickness wound, with a 3 cm laceration along the vermilion-cutaneous junction externally, extending to the inner mucosal surface of the lip. Forceps inside the wound highlight the separation of the vermilion from the surrounding skin, spanning the entire thickness of the upper lip. The patient is biting on a gauze pad to support the partially separated lip and control bleeding.

Figure 2.

(A) The 1.5 cm mucosal laceration, representing the internal extension of the full-thickness wound from the vermilion-cutaneous junction to the inside of the mouth near the left upper incisors, was sutured first using simple interrupted absorbable sutures and (B) the upper lip after multilayered repair, with superficial suturing at the vermilion-cutaneous junction using simple interrupted non-absorbable sutures.

Figure 3.

The upper lip 5 days post-repair, showing moderate swelling.

Figure 4.

The upper lip 1-week post-repair, after suture removal, showing mild swelling.

Figure 5.

The upper lip 6-week post-repair, showing a significant reduction in swelling, a well-defined vermilion-cutaneous junction, and no noticeable scarring.

Figure 6.

The upper lip at 4 months post-repair, showing good functional and cosmetic outcomes.