15220 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Name of the Procedure:

Full Thickness Graft, Free (Full-Thickness Skin Graft, FTSG)

Summary

A full-thickness graft involves taking a piece of skin from a donor site on the body and transplanting it to a recipient site where skin loss or damage has occurred. The donor site is directly closed by suturing the edges together. This procedure is typically performed on areas like the scalp, arms, and legs and is used when less than 20 square centimeters of skin is needed.

Purpose

Medical Condition:

This procedure addresses significant skin loss or damage due to trauma, burns, surgical removal of diseases like skin cancer, chronic ulcers, or congenital skin defects.

Goals and Outcomes:

• Restore skin integrity and function.
• Improve the appearance of the affected area.
• Promote better wound healing in the damaged or excised area.

Indications

Symptoms/Conditions:

• Non-healing ulcers or wounds.
• Post-surgical skin defects.
• Severe burns.
• Skin cancer excisions.
• Traumatic skin loss.

Patient Criteria:

• Good overall health.
• Adequate skin tone and elasticity at the donor site.
• No infections or severe vascular issues.

Preparation

Pre-Procedure Instructions:

• Avoid eating or drinking for 6-8 hours prior, if general anesthesia is used.
• Stop certain medications as advised by the healthcare provider.
• Arrange for transportation to and from the medical facility.

Diagnostic Tests:

• Blood tests.
• Skin assessment.
• Pre-operative imaging if necessary.

Procedure Description

Steps:

1. Donor Site Preparation: The donor area (scalp, arms, or legs) is sterilized and marked.
2. Anesthesia: Local or general anesthesia is administered.
3. Graft Harvesting: A full-thickness piece of skin is carefully excised from the donor site.
4. Placement: The skin graft is transplanted to the recipient site and secured with sutures or staples.
5. Closure of Donor Site: The edges of the donor site are sutured together to promote healing.
6. Dressing: Both the donor and recipient sites are covered with sterile dressings.

Tools and Equipment:

• Scalpel, sutures, staples.
• Sterile dressing materials.
• Anesthetic agents.

Duration

1-2 hours, depending on the complexity and size of the graft.

Setting

• Hospital operating room.
• Outpatient surgical center.

Personnel

• Plastic or general surgeon.
• Surgical nurse or assistant.
• Anesthesiologist (if general anesthesia is used).

Risks and Complications

Common Risks:

• Infection at donor or recipient site.
• Bleeding.
• Scarring.

Rare Complications:

• Graft rejection.
• Poor graft take or failure.
• Donor site complications such as hematoma or seroma.

Benefits

Expected Benefits:

• Restoration of skin functionality and appearance.
• Improved healing and reduced risk of infection.

Timeframe for Benefits:

• Initial healing typically seen within 2 weeks.
• Full benefits realized in a few months as the skin integrates with the surrounding tissue.

Recovery

Post-Procedure Care:

• Keep the graft and donor site clean and dry.
• Follow instructions for dressing changes.
• Avoid strenuous activities that might affect the graft.

Recovery Time:

• Initial recovery: 1-2 weeks.
• Full recovery: Several weeks to a few months.

Follow-Up:

• Regular follow-up appointments for monitoring healing and addressing any issues.

Alternatives

Other Treatment Options:

• Split-thickness skin grafts.
• Tissue expansion before grafting.
• Local flap surgeries.

Pros and Cons:

• Split-thickness grafts: Heal faster but may have a different appearance and texture.
• Local flaps: Use adjacent tissue but may not be feasible for large defects.

Patient Experience

During the Procedure:

• Minimal discomfort if local anesthesia is used; general anesthesia will mean the patient is asleep.
• Sensation of pressure or pulling at the donor and recipient sites.

After the Procedure:

• Mild to moderate pain, managed with oral pain medications.
• Swelling and bruising at both sites.
• Discomfort may persist for a few days but will gradually improve.