Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less
CPT4 code
Name of the Procedure:
Full Thickness Graft, Free (Including Direct Closure of Donor Site) for Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands, and/or Feet; 20 sq cm or Less
Summary
A full thickness graft (FTG) is a surgical procedure where a piece of tissue, including the full thickness of the skin, is taken from one part of the body (donor site) and transplanted to another area (recipient site). This procedure is used to cover and heal areas of damaged, absent, or excised skin, with the donor site closed directly after harvesting the graft.
Purpose
The procedure addresses medical conditions that involve skin loss or damage, such as severe injuries, burns, surgical resections due to cancer, or chronic ulcers. The goal is to restore the integrity and function of the skin in the affected area, ultimately improving appearance and aiding in the healing process.
Indications
- Large or deep wounds that cannot heal properly on their own.
- Non-healing chronic ulcers.
- Extensive burns.
- Skin cancer excisions.
- Traumatic skin loss.
- Congenital skin defects.
Preparation
- Fasting is usually required if general anesthesia will be used.
- Patients may be instructed to stop certain medications that can affect bleeding (e.g., blood thinners).
- Preoperative evaluations may include blood tests, imaging studies, and a thorough medical history.
Procedure Description
- Anesthesia: Local or general anesthesia is administered.
- Donor Site Selection: A suitable donor site is selected, typically an area with similar skin characteristics to the recipient site.
- Graft Harvesting: Using a scalpel, the surgeon carefully excises a full thickness skin graft (epidermis and entire dermis) from the donor site.
- Recipient Site Preparation: The damaged area is prepared, which may include debridement or surgical excision.
- Graft Placement: The harvested graft is placed over the recipient site and secured with sutures or surgical adhesive.
- Donor Site Closure: The donor site is closed directly with sutures to facilitate healing.
Duration
The procedure typically takes 1 to 2 hours, depending on the size and complexity.
Setting
The procedure can be performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Surgeon
- Anesthesiologist or nurse anesthetist
- Operating room nurses
- Surgical technician
Risks and Complications
- Infection at the donor or recipient site
- Graft failure or rejection
- Scarring at both sites
- Bleeding and hematoma formation
- Changes in skin sensation
- Poor cosmetic outcome
Benefits
- Effective healing of complex wounds
- Restoration of skin function
- Improved cosmetic appearance
- Reduced risk of infection in the treated area
- Faster and more efficient wound closure
Recovery
- Post-surgery, patients are advised to keep the graft site clean and dry.
- Pain management may involve prescribed medications or over-the-counter pain relief.
- Regular follow-up appointments to monitor healing.
- Activity restrictions to avoid stress on the grafted area, typically for a few weeks.
Alternatives
- Split-thickness skin grafts (only epidermis and part of the dermis)
- Skin substitutes or synthetic grafts
- Primary wound closure or flaps
- Negative pressure wound therapy (e.g., vacuum-assisted closure)
Patient Experience
During the procedure, patients will be under anesthesia and should not feel pain. Post-procedure, they may experience discomfort or pain at both the donor and recipient sites, which is manageable with medication. Patients might experience tightness or sensitivity in the grafted area, with ongoing improvement as healing progresses.