[SavageGlow]

A 30-year-old African man presented with a severe tissue defect on his lower lip (Figure 1) to a Dental and Oral Department in Tanzania. He had no past medical history of note.

He explained, while covering his mouth with a scarf, that 12 days ago he had been involved in a fight and someone had bitten his lower lip. After initial emergency first aid and several topic cures at a local dispensary, he was referred to the regional hospital. An orofacial examination confirmed a serious loss of lip tissue that resembled a chronic ulcerative process. Accurate assessment of the lesion was made by a thorough evaluation of some parameters such as size, depth, presence of granulation tissue, fibrin coverage, wound edges, exudates and/or necrosis.A surgical debridement and manual irrigation with normal saline under local anaesthesia was carried out. Afterwards a layered suture was performed with what we only had available at that service, catgut for muscular/subcutaneous tissues and silk for skin/oral mucosa. There was some over tension around the vertical mattress sutures as it was important to get a correct primary wound closure (Figure 2). Postoperative medical treatment included oral analgesics (ibuprofen 400mg 8 hourly for 5 days) and broad spectrum oral antibiotics coverage (amoxicillin 500mg 8 hourly for 5 days in combination with metronidazole 500mg 8 hourly for 5 days). In order to avoid a possible cicatrization failure, silk sutures were removed after 2 weeks. Eventually the healing was complete and satisfactory (Figure 3).