Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Dermal Autograft, Trunk, Arms, Legs; each additional 100 sq cm, or each additional 1% of Body Area of Infants and Children, or Part Thereof
Summary
A dermal autograft involves transplanting skin from one area of the patient’s body (donor site) to another area that needs repair (recipient site). This specifically applies to additional areas measuring 100 square centimeters or 1% of body area in infants and children.
Purpose
The procedure is primarily used for repairing large areas of skin damage due to burns, trauma, or surgical operations. Grafting aims to restore skin function and appearance, promote wound healing, and prevent infection.
Indications
The procedure is indicated for patients with extensive skin loss or damage, especially from burns or severe wounds. It’s suitable for individuals where primary repair methods aren't sufficient. It may also be recommended for skin defects that cannot heal on their own.
Preparation
- Follow fasting instructions as directed, typically nil per os (NPO) after midnight before surgery.
- Adjust or cease certain medications, especially blood thinners, under medical guidance.
- Undergo pre-operative assessments like blood tests, imaging studies, and possibly a psychological evaluation for preparation.
Procedure Description
- Administer anesthesia (general or regional), ensuring the patient is comfortable and pain-free.
- Harvest skin from a donor site, which is usually taken from an area hidden under clothing, such as the thigh or buttocks.
- Prepare the recipient site by cleaning and removing damaged tissue.
- Place the harvested skin over the recipient site and secure it with sutures, staples, or adhesive materials.
- Cover the graft site with a sterile dressing to protect and keep it moist.
Tools include dermatome for harvesting skin, surgical instruments for securing the graft, and sterile dressing materials.
Duration
The procedure typically takes a few hours, depending on the extent of the area being grafted and the specific needs of the patient.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon (plastic or reconstructive)
- Surgical nurses and technicians
- Anesthesiologist or nurse anesthetist
- Possibly a pediatric specialist, if the patient is a child
Risks and Complications
- Infection at donor or recipient site
- Graft failure (graft may not adhere properly or survive)
- Scarring and changes in skin pigmentation
- Pain or discomfort at donor and recipient sites
- Rarely, an allergic reaction to anesthesia
Benefits
- Restoration of skin integrity and appearance
- Accelerated wound healing
- Reduced risk of infection and further complications
- Improved functionality of the affected area
Benefits are generally seen within a few weeks as the graft heals and integrates with the surrounding tissue.
Recovery
- Follow detailed wound care instructions provided by the healthcare team.
- Avoid strenuous activities and follow any restrictions on movement.
- Schedule regular follow-up appointments for assessment and monitoring of graft success.
- Expect complete recovery to take several weeks, with restrictions gradually easing.
Alternatives
- Synthetic skin substitutes, although might not be as effective.
- Split-thickness skin grafts for smaller or superficial wounds.
- Healing with secondary intention, which involves natural healing but takes longer and might result in more noticeable scarring.
Patient Experience
- Patients may feel soreness or pain at the donor and recipient sites, managed with prescribed pain relief medications.
- They may experience tightness and limited mobility temporarily.
- Regular dressings and care are essential for comfort and successful healing.
- Most patients express a gradual return to normal activities within weeks, with scars fading over time.