Name of the Procedure:

Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less

Summary

This procedure involves the intermediate repair of wounds that are 2.5 centimeters or less on the scalp, underarms (axillae), trunk, and extremities (but not on the hands or feet). "Intermediate repair" here means that the wound is repaired with at least one layer of sutures placed below the surface layer of the skin to minimize the risk of scarring and enhance healing.

Purpose

Address conditions like deeper cuts or lacerations that penetrate through the dermis and may risk infection or improper healing if left untreated. The aim is to ensure proper wound healing, minimize the risk of infection, and achieve the best possible cosmetic outcome.

Indications

• Lacerations or cuts that are deeper than superficial wounds
• Wounds that are susceptible to infection or poor healing
• Patient's medical history and wound location necessitate intermediate repair for effective healing

Preparation

• Follow pre-procedure instructions from the healthcare provider, which may include cleaning the wound area
• Fasting is typically not required
• Provide a medical history, including current medications and allergies
• Possibly, a tetanus shot if the wound is caused by a dirty or rusty object

Procedure Description

1. Assessment: The healthcare provider examines the wound to determine the extent and the need for intermediate repair.
2. Cleaning: The wound area is thoroughly cleaned to remove debris and assess for further damage.
3. Anesthesia: Local anesthesia is administered to numb the area.
4. Repair: The wound is closed using multiple layers of sutures:
   • Deep layers closed with dissolvable sutures to provide structure.
   • Outer layer stitches to close the skin.
5. Dressing: Sterile bandages or dressings are applied to protect the wound.

Tools include suture materials, needle holders, forceps, scissors, and sometimes wound adhesive strips or tapes.

Duration

Typically around 15 to 30 minutes, depending on the complexity of the wound.

Setting

Performable in a hospital emergency room, outpatient clinic, or surgical center.

Personnel

• Physician (Surgeon or an Emergency Room Doctor)
• Nurses or medical assistants for preparation and post-procedure care

Risks and Complications

• Infection at the wound site
• Scarring
• Suture reaction (inflammation or allergy)
• Hematoma (accumulation of blood)

Benefits

• Proper wound healing and minimizing infection risk
• Improved cosmetic outcome due to layered suturing
• Reduced healing time compared to natural closure

Recovery

• Keep the wound clean and dry
• Follow specific wound care instructions, such as changing dressings and applying antibiotic ointment
• Limit activity that may strain the wound area
• Expect removal of non-dissolvable stitches in 7-14 days
• Follow-up appointment as recommended

Alternatives

• Simple wound repair: only suitable for less complex, superficial wounds
• Advanced wound care: for more complex or larger wounds potentially warranting a surgical procedure
• Comparison: Intermediate repair offers a balance between superficial and more invasive methods, optimal for deeper but not extensively large cuts

Patient Experience

• During: Mild pressure or pulling sensation; minimal pain due to local anesthesia
• After: Some discomfort or soreness in the repaired area, manageable with over-the-counter pain relief
• Immediate post-procedure instructions and follow-up care are essential for optimal healing and comfort.