Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Suture of Skin and Subcutaneous Tissue


Related Terms

  • Skin Closure
  • Stitches
  • Wound Repair

Specialists

  • Dermatologist
  • Emergency Medicine Physician
  • Family Physician
  • General Surgeon
  • Hand Surgeon
  • Plastic Surgeon

Comorbid Conditions

Factors Influencing Duration

Factors include the underlying cause for the procedure, severity of the injury, location of the stitches, any separation (dehiscence) of the wound, or the development of an infection.

Medical Codes

ICD-9-CM:
86.59 - Closure of Skin and Subcutaneous Tissue of Other Sites

Overview

Suture literally means "join." Surgical suture is often called a stitch, or a series of stitches, which can be used to close the edges of a wound (laceration) or a surgical incision. Sutures may also be used to hold intravenous lines and surgical drains in place. Several types of suture material, techniques for placing the sutures, and needles to hold the suture material may be used.

Choice of suture material and technique depends on several factors including the purpose, wound configuration, location, and depth of the wound. Suturing may be percutaneous or dermal (subcuticular) often described as a skin closure. Percutaneous closure passes through both the epidermal and dermal layers of the skin, while in dermal closure the outermost layer of the skin (epidermis) is not entered (which results in the suture material not visible on the skin). Sutures may be placed either as a continuous stitch (running) or as an interrupted suture in which every stitch is knotted and cut.

There are a variety of suture materials and sizes available. Because suturing can result in inflammation and scarring, the smallest-size suture material and the least possible number of stitches that will maintain closure are used. Suture materials may be either absorbable (synthetic, plain gut, chromic gut) or nonabsorbable (nylon and polypropylene, Dacron, metal, silk, and cotton).

Source: Medical Disability Advisor



Reason for Procedure

Sutures secure the edges of a wound (laceration) or surgical incision, and promote healing of the injured area. Suturing reduces "dead space" inside the wound where bacteria and secretions may accumulate, stops excessive bleeding, and provides physical strength to a skin surface that has been injured or cut. Closing the skin also helps prevent infection of the tissue beneath. The edges of the wound will start to seal together, which can reduce the chances of infection, in about 6 hours if the edges are carefully aligned (opposed) and have not been disturbed following suturing.

Lacerations and cuts as a result of trauma require cleaning and trimming of dead or nonviable tissue (débridement). Cleansing and débridement decreases the chance of infection and may lessen scarring.

Sutures may be used to hold deep intravenous (IV) lines and surgical drains in position. IV lines inserted into the large, deep veins near the heart (central venous catheters) may be placed in critically ill individuals with life-threatening medical conditions, or with trauma as a result of automobile accidents, burns, or any other severe injury, who require long-term hospitalization and intravenous nutrition (total parenteral nutrition [TPN]). Specialized IV lines may be positioned into arteries (arterial lines) for blood pressure monitoring in individuals who are critically ill or for monitoring other parameters and for blood drawing during anesthesia. Arterial lines may be sutured to the skin to help maintain placement. Drains placed during surgery may also be secured to the skin with stitches.

Source: Medical Disability Advisor



How Procedure is Performed

Suturing can be performed under local, regional, or general anesthesia. For traumatic wounds, the wound is cleansed and irrigated with an antibacterial solution, and any tissue that will not survive is removed (débrided). In the case of traumatic wounds, underlying structures, nerves, and tendons are assessed for proper functioning prior to suturing of the skin. Sometimes if the wound has poor blood supply, the wound will be left open for a few days and then a secondary wound closure is done. Suture placement will vary with the techniques used, but in general the threaded needle passes into one edge of the skin, through the full depth of the wound, and out the other skin edge. All tissue layers are aligned together (approximated) as carefully as possible. Skin sutures are removed after the wound has healed. Internal sutures, made of absorbable material, are used to close subcutaneous (under the skin) tissues. They are left in place permanently and are eventually dissolved by the tissue fluids.

Source: Medical Disability Advisor



Prognosis

The predicted outcome of suturing is generally good. Suturing allows skin to heal. Once healed, the skin can again perform the functions of regulating body temperature; permitting the sensations of touch, heat, and cold; and protecting from microbes and environmental elements.

Source: Medical Disability Advisor



Rehabilitation

Rehabilitation is not generally needed following suturing. Wound management will improve wound or skin healing, and may include special bandages, wraps, and scar massage. Additional rehabilitation will depend on other associated injuries or conditions.

Source: Medical Disability Advisor



Complications

Complications of suturing may include local inflammation, infection, tearing of the skin resulting in separation of the incision (dehiscence), and scarring.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations depend on the type of work responsibilities and the work environment. The sutured area must remain clean, dry, and intact in order to prevent the wound from becoming infected or reopening. If suturing is placed over a joint, mobility may be impaired until healing is completed.

Risk: The wound edges must be protected for the first 2 weeks while the skin heals. Excessive activities can result in damage to the wound or delayed wound healing.

Capacity: The ability to work (capacity) may be affected by the location and size of the wound(s) and any associated injuries. Capacity will also be based on traditional wound healing requirements.

Tolerance: Some wounds will be more painful than others. The amount of pain would be based on the location and size of the lesion and the individual's tolerance for pain. Each individual is unique regarding their ability to tolerate pain.

Accommodations: Accommodations may be appropriate based the wound location and size and the individual’s tolerance. Keeping the sutured area dry and clean for 2 weeks may impact job options.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 to 28 days.

Source: Medical Disability Advisor



References

Cited

Owings, William O. "Wound Management." Saunders Manual of Medical Practice. Ed. Robert E. Rakel. 2nd ed. W.B. Saunders, 2000. 1310-1312.

Source: Medical Disability Advisor






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