Wiki laceration repair help

[ggparker14]

Can I get your opinion on whether this would be an intermediate or complex repair?

Location: face, nose and right side. Length: 8.0cm. Complexity: complex (requiring alignment of multiple flaps), intermediate (layer closure) and simple (local anesthesia used and sutured).
Wound depth/shape- subcutaneous, irregular and with multiple flaps. No tissue loss. Distal neuro/vascular/tendon status normal. Local anesthesia provided using 1% lidocaine no epi. Wound explored, cleansed and irrigated extensively with normal saline. Closure of skin: 5-0 Prolene (27 sutures). Subcutaneous closure: 5-0 Vicryl (8 sutures). Post-procedure: he is stable and there are no complications. Bleeding is controlled. Estimated blood loss: 15 mL.

Thank you for any help.

 

[hsievers]

If this procedure was done in the ED, I would code an intermediate repair, two layers were repaired. I was taught that a complex repair usually requires an operating room, because it involves deep tissue such as muscle, tendons etc. That level of repair is not usually done in an ED setting.

 

[sswisher]

ggparker14--Documentation supports intermediate. No mention of revision/creating a defect/undermining etc that would bump the repair to a complex. Aligning multiple flaps does not in itself make the repair complex. It probably took a long time to suture this, but it is what is.

hsievers--You wrote "If this procedure was done in the ED, I would code an intermediate repair..." I agree that the repair was intermediate but that has nothing to do with whether or not it was done in the ED. Certainly some complex lacerations go to the OR, but many do not. It varies a lot from facility to facility. The decision regarding whether or not to go to the OR is frequently determined by time constraints, skill of the ED provider, availability of specialists, availability of OR slots, whether or not the ED is a teaching facility and multiple other local factors.