LAUSR

undermining” as one possible criterion for coding a repair as complex; however, it is now less subjectively defined as undermined “distance equal to or greater than the maximum width of the defect, measured perpendicular to the closure line along at least one entire edge of the defect.” Measuring undermining as defined by the revised CPT guidelines can be challenging, especially for smaller wounds. We present an effective method to measure undermining using a sterile cotton-tipped applicator (CTA). The wooden end of the CTA is inserted beneath the wound edge and gently advanced to the peripheral margin of undermining (Figure 1A). The CTA is then removed, and the distance of sanguineous fluid is measured against a ruler as a proxy for the length of undermining (Figure 1B). This method recruits supplies often already present on the surgical tray and is easy, fast, and accurate. The primary disadvantage is that measurement may not be feasible if the wound is dry. However, in our experience there is often enough residual fluid (blood, serum, and surgical prep) present within the defect to mark the CTA.