Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or
CPT4 code
Name of the Procedure:
Surgical Preparation or Creation of Recipient Site by Excision of Open Wounds, Burn Eschar, or Scar (Including Subcutaneous Tissues), or Incisional Release of Scar Contracture
Summary
This surgical procedure involves the removal of damaged tissues such as open wounds, burn eschar, or scars to prepare a recipient site for skin grafting or to release tightened skin due to scarring. It may be performed on various parts of the body, including the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, and feet.
Purpose
- Medical Condition or Problem: The procedure addresses severe scars, burn eschars, open wounds, or contractures that limit movement or cause significant cosmetic or functional issues.
- Goals: The primary goals are to prepare the area for skin grafting, to restore normal function and appearance, or to relieve tension caused by scar contractures.
Indications
- Excessive scarring or open wounds that have not healed properly
- Burns that have resulted in eschar formation
- Scar contractures limiting movement or function
- Patients requiring reconstruction in areas such as the face, hands, or other critical body parts
Preparation
- Pre-procedure instructions might include fasting for a certain period before surgery.
- Adjustments to medications may be necessary, particularly blood thinners.
- Diagnostic tests or assessments such as blood work, imaging studies, or a physical examination might be required beforehand.
Procedure Description
- Anesthesia: The procedure is typically performed under local or general anesthesia, depending on the location and extent of the area being treated.
- Incision and Excision: The surgeon makes precise incisions to remove the damaged tissues, including the skin and subcutaneous layers.
- Release of Contracture: If scar contracture is present, the surgeon releases the tightened scar tissue to allow for more normal skin movement.
- Preparation for Grafting: The site is carefully prepared for any potential skin grafting, ensuring a healthy bed for the graft to adhere to.
- Closure: If grafting is not immediately performed, the site may be temporarily covered and scheduled for future reconstructive steps.
Duration
The procedure typically takes 1 to 3 hours, depending on the extent and complexity of the areas being treated.
Setting
The surgery is performed in a hospital, outpatient surgical center, or specialized clinic.
Personnel
- The surgical team usually consists of a plastic or reconstructive surgeon, nurses, anesthesiologist, and surgical technicians.
Risks and Complications
- Common risks include infection, bleeding, and scarring.
- Rare risks comprise adverse reactions to anesthesia, poor wound healing, and graft failure if grafting is performed.
- Complications are managed with appropriate medical or surgical interventions.
Benefits
- The expected benefits include improved function, enhanced cosmetic appearance, and relief from pain or discomfort caused by contractures.
- Benefits might be noticed immediately after recovery but typically become more apparent over a few weeks to months.
Recovery
- Post-procedure care includes wound management, pain control, and adherence to activity restrictions.
- The expected recovery time varies but typically ranges from several weeks to a few months.
- Follow-up appointments are crucial for monitoring healing and addressing any complications.
Alternatives
- Non-surgical options include laser therapy, steroid injections, or physical therapy.
- The pros of alternatives may include less invasiveness, though they might not be as effective for severe cases. Conversely, the described surgical procedure is more definitive but comes with higher risks.
Patient Experience
- During the procedure, the patient is under anesthesia and should not feel pain.
- Post-procedure, patients may experience pain, swelling, or discomfort, manageable with prescribed pain medication and care measures.
- Physical therapy or additional treatments might be recommended to aid in recovery and function restoration.