Laceration Repair-I do very few

Mklaubauf

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HI,
I do very few laceration repairs, so any help would be greatly appreciated.

Here is the operative note
Preop Dx. Traumatic injury of Left lower extremity with greater than 6-8cm laceration, full thickness.
Postop Dx.Full thickness laceration with some subcutaneous tissue loss, avulsion injury, ischemic tissue
Procedure: Irrigation with Pulsavac, debridement of obviously devitalized tissue, and primary closure of traumatic injury.

Procedural note: The left lower extremity was prepped and draped in a sterile fashion. It had been previously irrigated and washed in the emergency room.

At this juncture there wa sno obvious particulate or foreign debris within the wound. Pulsavac irrigation was commenced with 3 liters of solution. The patient did not have violation of the deepest fascial layer over the anterior shin. There was no exposed periosteum. The fascial layer of the muscular compartment anteriorly was not violated. After the irrigation was performed I did approximate the subcutaneous tissue at the inferiomost portion of the wound;however, the other portions of the wound had somewhat of a subcutaneous tissue loss such that I could not approximate the subcutaneous tissue with absorbable suture; however, I could bring together the skin flaps and did so with interrupted vetical mattress 4-0 nylon sutures and I did interspace these with additional sutures of 5-0silk, some interrupted, some vertical matress, and in this manner I was able to achieve a complete primary closure. The inferior portion of the wound and an area of perhaps 0.5% total body surface area, maybe a 3X6area portion was an avulsion injury that was a full dermal flap. This did appear to be viable, however, and I approximated this faily meticulously with 5-0 nylon. Following the closureTriple Antibiotic ointment was placed and then he dresses the wound.

My question is this an intermediate repair or would this be complex? I'm thinking intermediate, 12037
Any help is greatly appreciated.
Marci
 

hairey

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I believe it is complex. Those codes include debridement, irrigation, trimming to allow proper closure and layered closure.
 
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