Name of the Procedure:

Repair, Intermediate, Wounds of Scalp, Axillae, Trunk, and/or Extremities (Excluding Hands and Feet); 20.1 cm to 30.0 cm

Summary

This procedure involves the intermediate repair of wounds on areas such as the scalp, armpits, trunk, and limbs but excludes hands and feet. Intermediate repair typically involves layered closure of one or more wounds, which means that the deeper layers are closed with sutures, and surface layers are closed separately.

Purpose

The procedure addresses wounds that require more than a simple one-layer repair but do not need the extensive techniques used in complex repairs. The goal is to promote proper healing while minimizing scarring and the risk of infection.

Indications

• Lacerations or cuts that are between 20.1 cm to 30.0 cm in length.
• Wounds that penetrate through the dermis and require layered closure.
• Patients with injuries in areas prone to higher levels of movement or tension.

Preparation

• Patients may be advised to fast if sedation is planned.
• Adjustments to medications may be necessary, especially blood thinners.
• Diagnostic tests such as blood work to ensure fitness for anesthesia and surgery may be required.

Procedure Description

1. Cleaning and sterilization of the wound area.
2. Administration of local anesthesia; sedation may be used depending on the patient's needs.
3. Layered closure of the wound:
   • Deep layers are closed first using absorbable sutures.
   • Superficial layers are then closed using non-absorbable sutures, stitches, or staples.
4. Application of sterile dressing to protect the repair.

Tools and Equipment:

• Sutures (absorbable and non-absorbable)
• Scalpels and scissors for trimming tissue
• Needle holders and forceps for precision

Note: In some cases, additional techniques such as skin grafting or flap closure might be required.

Duration

The procedure typically takes between 30 minutes and an hour, depending on wound complexity and patient-specific factors.

Setting

• Hospital outpatient department
• Surgical center

Personnel

• Surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection
• Scarring
• Bleeding
• Reaction to anesthesia
• Wound dehiscence (reopening of the wound)
• Nerve damage (rare)

Benefits

• Proper wound healing
• Minimized risk of infection and further complications
• Reduced scarring

Recovery

• Keep the wound clean and dry.
• Follow up with regular wound care and dressing changes as directed.
• Limited movement or use of the affected area to facilitate healing.
• Follow-up appointments to monitor the wound and remove non-absorbable sutures.

Alternatives

• Simple repair with a single layer closure (suitable for smaller, less deep wounds).
• Complex repair involving flaps, grafts, or more intricate surgical techniques (for more severe wounds or cosmetic concerns).
• Conservative management with wound care and natural healing (may involve longer healing time and increased scarring).

Patient Experience

• Patients may feel pressure but should not feel pain during the procedure due to local anesthesia.
• Post-procedure pain and discomfort are typically managed with prescribed medications.
• Mild swelling and bruising are common but should subside in a few days.