Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)
CPT4 code
Name of the Procedure:
Grafting of Autologous Soft Tissue, Other (Harvested by Direct Excision, e.g., Fat, Dermis, Fascia)
Summary
Grafting of autologous soft tissue involves taking tissue from one part of the patient's body and transplanting it to another area. The tissue is harvested by direct excision, meaning it is surgically removed from a donor site (e.g., fat, dermis, fascia) and then grafted to the treated site.
Purpose
This procedure addresses defects or deficiencies in soft tissue caused by trauma, surgery, congenital anomalies, or other medical conditions. The main goal is to restore the form and function of the affected area by using the patient's own tissue, which reduces the risk of rejection.
Indications
- Soft tissue defects due to trauma, surgery, or congenital anomalies
- Reconstruction following mastectomy or other surgical procedures
- Cosmetic enhancement or correction of contour deformities
- Scar revisions
Patient criteria:
- Adequate donor sites with sufficient tissue
- Good general health and non-smoking status to ensure optimal healing
Preparation
- Pre-procedure consultation to discuss goals, risks, and expectations
- Fasting for at least 6-8 hours prior if general anesthesia is to be used
- Pre-operative blood tests and possibly imaging studies
- Medication adjustments (e.g., avoiding blood thinners)
Procedure Description
- Anesthesia: Administer either local anesthesia with sedation or general anesthesia.
- Tissue Harvesting: A direct excision technique is used to obtain tissue from donor sites such as the abdomen (fat), thigh (fascia), or behind the ear (dermis).
- Preparation: The harvested tissue is prepared and shaped appropriately for grafting.
- Grafting: The prepared tissue is meticulously placed and secured in the recipient area.
- Closure: Both donor and recipient sites are sutured closed and dressed with sterile bandages.
Tools/technology: Scalpel, forceps, sutures, possibly microsurgical instruments.
Duration
The procedure typically takes 2-4 hours, depending on the complexity and size of the graft.
Setting
The procedure is performed in a hospital or an accredited surgical center.
Personnel
- Lead surgeon (plastic/reconstructive surgeon)
- Surgical assistants
- Nurses
- Anesthesiologist (if general anesthesia is used)
Risks and Complications
- Infection
- Bleeding or hematoma
- Scarring
- Graft failure or resorption
- Anesthesia-related complications
- Prolonged swelling or bruising
- Uneven texture or contour irregularities
Benefits
- Restoration of normal appearance and function
- Low risk of rejection since the tissue is autologous
- Enhanced aesthetic results in reconstructive or cosmetic applications
Benefits are often noticeable immediately, with continued improvement as swelling subsides over several weeks.
Recovery
- Post-procedure: Patients are monitored for a few hours in recovery
- Pain management: Prescribed pain relievers and anti-inflammatory medications
- Care instructions: Keeping the grafted and donor sites clean and dry, following wound care instructions
- Restrictions: Limited physical activity for 2-4 weeks to allow for proper healing
- Follow-up: Regular visits to assess healing and graft success
Recovery time varies but generally spans 4-6 weeks for most activities, with full results evident by 3-6 months.
Alternatives
- Synthetic or donor tissue grafts: Avoids harvesting from the patient but has a higher rejection risk.
- Dermal fillers or fat transfer: Less invasive but may provide less durable results.
- Flap reconstruction: More complex and may involve larger areas of tissue transfer.
Pros and cons should be discussed with a healthcare provider to determine the most appropriate option.
Patient Experience
During the procedure, patients should expect to be under anesthesia or sedation, so they will not feel pain. Post-procedurally, some discomfort, swelling, and bruising are common and managed with prescribed medications. Patients should arrange for support at home during the initial recovery period for optimal healing and comfort.