Name of the Procedure:

Repair, intermediate, wounds of neck, hands, feet, and/or external genitalia; 2.5 cm or less

Summary

This is a surgical procedure performed to repair and close intermediate wounds located on the neck, hands, feet, or external genitalia that are 2.5 cm or less in size. Intermediate repairs typically involve layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure.

Purpose

The purpose of this procedure is to effectively close and heal wounds that are deeper than just the superficial skin. Proper closure of these wounds reduces the risk of infection, promotes better healing, and minimizes scarring. This procedure is often necessary to address wounds caused by trauma, surgeries, or other medical conditions that have resulted in a break in the skin and underlying tissue.

Indications

• Lacerations or cuts on the neck, hands, feet, or external genitalia that are 2.5 cm or smaller
• Wounds requiring layered closure due to their depth and location
• Patients with wounds that are not healing properly, risking infection or other complications
• Cases where fine motor skills and high functionality of the hands or feet need to be preserved

Preparation

• Patients may need to fast for several hours before the procedure, especially if anesthesia is used.
• Pre-procedure testing may include blood tests, allergy screening, and a physical examination.
• Adjust or halt certain medications as directed by the physician, especially blood thinners.
• Clean and shave the area around the wound if necessary.

Procedure Description

1. Assessment: The wound is first thoroughly examined and cleaned.
2. Anesthesia: Local anesthesia is administered to numb the area; in some cases, sedation or general anesthesia may be used.
3. Debridement: Any dead or contaminated tissue is removed to prevent infection.
4. Layered Closure: The deeper layers of tissue are stitched together first, followed by the superficial layers.
5. Skin Closure: The outer layer of skin is closed using sutures, staples, or adhesive strips.
6. Dressing: A sterile dressing is applied to protect the wound and promote healing.

Tools used may include sutures, needles, surgical scissors, and possibly a surgical stapler.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity of the wound.

Setting

This procedure can be performed in a hospital, outpatient clinic, or a surgical center.

Personnel

• A surgeon or qualified physician
• Assisting nurses or surgical technologists
• An anesthesiologist or nurse anesthetist if sedation or general anesthesia is needed

Risks and Complications

• Infection at the wound site
• Bleeding or hematoma formation
• Scarring
• Nerve damage resulting in altered sensation
• Allergic reactions to anesthesia

Benefits

• Effective wound closure and healing
• Reduced risk of infection
• Minimization of scarring
• Preservation of function and aesthetics in the affected area
• Faster recovery time compared to more extensive surgical procedures

Recovery

• Keep the wound clean and dry for the recommended period.
• Follow wound care instructions provided by the healthcare team.
• Take prescribed pain medications and antibiotics as directed.
• Avoid strenuous activities that might disrupt the wound healing.
• Attend follow-up appointments for wound check and suture removal, if applicable.
• Full recovery typically ranges from a few weeks to a month.

Alternatives

• Non-surgical wound care with dressings and topical agents, which may be less effective for deeper wounds.
• Simple wound closure techniques for less complex cases, which might not address deeper tissue layers.
• Use of medical-grade adhesive tapes or glue.

Patient Experience

Patients may feel minimal discomfort due to local anesthesia during the procedure. Post-procedure, there might be some pain, swelling, or bruising at the site. Pain management includes prescribed analgesics and over-the-counter pain relief. Patients are advised to follow all aftercare instructions to ensure proper healing and minimize discomfort.