Name of the Procedure:

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes (2.6 cm to 5.0 cm)

Summary

This procedure involves the repair of moderately complex wounds located on the face, ears, eyelids, nose, lips, and/or mucous membranes. Intermediate repair includes the closure of one or more superficial wounds that require layered closure of one or more deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin (epidermal and dermal) closure.

Purpose

The procedure addresses wounds that are not simple and require more intricate stitching techniques. The goal is to improve wound healing, minimize infection risk, and achieve better cosmetic outcomes compared to simple wound repair.

Indications

• Lacerations or cuts on the face, ears, eyelids, nose, lips, or mucous membranes that are between 2.6 cm to 5.0 cm in length.
• Wounds that require layered closure due to deep involvement of subcutaneous tissue.
• Patients needing improved cosmetic results from the wound repair.
• Presence of wounds that are not suitable for simple closure techniques.

Preparation

• Patients may be instructed to fast for a few hours before the procedure if sedation or general anesthesia is planned.
• Discontinue certain medications as advised by the healthcare provider (e.g., blood thinners).
• Undergo necessary blood tests or imaging studies to assess the extent of the injury and plan the repair.

Procedure Description

1. Anesthesia: Local anesthesia is typically administered to numb the area. For more anxious patients or more complex repairs, sedation or general anesthesia might be used.
2. Wound Cleaning: The wound is thoroughly cleaned to prevent infection.
3. Debridement: Any dead or contaminated tissue is removed.
4. Layered Closure: The deeper layers of tissue are closed with absorbable sutures. The skin is then closed, usually using non-absorbable sutures for better cosmetic results.
5. Final Check: The wound is checked for proper alignment and hemostasis.
6. Dressing: A sterile dressing is applied to protect the wound.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the complexity and length of the wound.

Setting

This procedure is usually performed in an outpatient clinic, a surgical center, or occasionally in a hospital setting if the patient requires general anesthesia.

Personnel

• A surgeon or dermatologic surgeon performs the procedure.
• A nurse assists with the preparation and post-procedure care.
• An anesthesiologist may be involved if general anesthesia or sedation is used.

Risks and Complications

• Common Risks: Infection, bleeding, scarring.
• Rare Risks: Wound dehiscence (reopening), allergic reactions to sutures or anesthetics, nerve damage.
• Management: Infection can be treated with antibiotics; bleeding controlled with pressure dressings or additional sutures; and other complications managed by healthcare providers as necessary.

Benefits

• Enhanced cosmetic appearance and function of the repaired area.
• Reduced risk of wound infection and complications.
• Improved healing due to the correct alignment of tissues.

Recovery

• Keep the wound clean and dry as directed.
• Avoid strenuous activities that may stress the wound site.
• Follow-up appointments to remove stitches (if non-absorbable) and check healing.
• Recovery time varies but is generally between 1 to 2 weeks for initial healing, with continued improvement in scar appearance over several months.

Alternatives

• Simple Closure: Suitable for less complex wounds but may result in less optimal cosmetic outcomes.
• Advanced Wound Care: Including skin grafts or flaps, if the wound is particularly large or complex.
• Pros and Cons: Simple closure is quicker with less cost but possibly more prominent scarring; advanced options offer better cosmetic results but are more complex and involve longer recovery.

Patient Experience

• During Procedure: With local anesthesia, the patient will feel minimal pain, just pressure or movement.
• After Procedure: Mild discomfort or pain managed with prescribed analgesics.
• Care Measures: Pain management with over-the-counter pain relievers, avoiding direct sunlight on the wound to reduce scarring, and keeping the wound clean are important for optimal recovery.