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SURGICAL REPAIRS

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SUMMARY

  • Laceration repairs are often the first closures attempted by primary care clinicians. Ensuring that the wound is clean with fresh edges—and that it has been thoroughly anesthetized—is critical.

  • Lacerations can be closed with a layered technique.

  • Remember to focus on careful technique with well-approximated and slightly everted wound edges for ideal long-term cosmesis.

image Beginner Tips

  • Ensure that the wound has been thoroughly cleaned and is free from foreign bodies before even considering starting your repair.

  • Interrupted sutures have the advantage of resilience in the face of inadvertent suture material breakage.

  • Running sutures, while nominally faster to place, will lose all their retention if the suture material breaks anywhere along its course.

image Expert Tips

  • It is possible to entirely close a laceration with buried sutures alone.

  • Sutures may be spaced closer together where the wound is under the greatest tension, though most lacerations are only under minimal tension.

  • Wounds do not need to be closed in a straight line; for shark-fin shaped lacerations, a tip stitch may be useful.

image Don’t Forget!

  • Suture removal can be inconvenient and painful. In select cases, it may be appropriate to close the wound entirely with buried sutures or with fast-absorbing transepidermal sutures (or a combination of the two).

  • Avoid nylon sutures around the lips and eyes, where they can poke and represent a source of discomfort for the patient.

image Pitfalls and Cautions

  • Never close a wound unless you are certain that all debris has been removed.

  • In cases of extreme crush injuries, it may be better to debride the devitalized area at the time of the initial repair rather than allow frank necrosis to set in, when an additional procedure will be needed with potentially increased morbidity.

image Patient Education Points

  • Expect bruising to increase for 2-3 days after the laceration repair, and for forehead or periorbital trauma, patients should expect a black eye that will worsen over several days before improving.

  • Minimizing the need for dressing changes can be very helpful for patients, and select wounds can be dressed with adherent film dressings, particularly when no transepidermal sutures are used.

image Billing Pearls

  • Lacerations are generally billed with the simple repair series of codes based on the length of the repair.

  • When repairing lacerations with a layered repair including buried sutures, intermediate repair codes can be used.

  • Lacerations are almost never be billed as complex closures or as flap repairs.

INTRODUCTION

Laceration repairs are among the most frequently performed procedures in office practice. The central principles of laceration repair are the same as those for any linear excision and repair: minimize tension, minimize the presence of foreign body material, precisely align wound edges, and minimize dead space and bleeding prior to closure. Because the mechanism of injury is generally traumatic rather than iatrogenic, laceration ...

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