15120 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Name of the Procedure:

Split-thickness autograft (STSG), involving the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children.

Summary:

A split-thickness autograft is a surgical procedure where a thin layer of skin is removed from a donor site on the patient's body and transplanted to an area that has sustained significant skin loss or damage. This particular description covers grafts applied to sensitive areas such as the face, scalp, eyelids, mouth, neck, ears, and genitalia, among others.

Purpose:

This procedure primarily serves to treat severe skin injuries such as burns, extensive wounds, or surgical sites that cannot naturally heal. The goal is to restore skin integrity and functionality, protect underlying tissues, and improve aesthetic appearance.

Indications:

• Severe burns
• Large traumatic wounds
• Surgical wounds that require skin coverage
• Chronic skin ulcers
• Areas that failed to heal after other treatments

Preparation:

• Fasting for a specific period as advised by the surgeon (usually 6-8 hours prior)
• Adjustment or temporary cessation of certain medications
• Preoperative evaluation including blood tests, imaging studies
• Consultation with an anesthesiologist

Procedure Description:

1. Anesthesia: The patient is administered either general anesthesia or local anesthesia with sedation.
2. Preparation of Donor Site: A skin graft is taken from a donor site (commonly the thigh or buttock). The skin is carefully cut to a thin layer using a dermatome instrument.
3. Preparation of Recipient Site: The area receiving the graft is thoroughly cleaned and prepared.
4. Application of Graft: The harvested skin is skillfully placed over the recipient area and secured with sutures or special adhesives.
5. Dressing: Both donor and graft sites are dressed appropriately to promote healing and prevent infection.

Duration:

The procedure typically takes 1 to 2 hours, depending on the size and complexity of the area being grafted.

Setting:

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel:

• Surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications:

• Infection
• Bleeding
• Graft failure or rejection
• Scarring
• Donor site complications (e.g., delayed healing, infection)
• Sensation changes in grafted area

Benefits:

• Enhanced healing and recovery of damaged areas
• Preservation of function in areas with extensive damage
• Improved cosmetic outcomes
• Protection of underlying tissues

Recovery:

• Keep both donor and graft sites clean and protected
• Follow post-operative care instructions, including wound care and activity restrictions
• Pain management typically involves prescribed medications
• Initial healing may take 2-4 weeks, with full recovery and maturation of the graft taking several months
• Follow-up appointments to monitor graft integration.

Alternatives:

• Full-thickness skin grafts, though with different indications and healing properties
• Skin substitutes and synthetic grafts
• Non-surgical wound care, though less effective for extensive damage
• Hyperbaric oxygen therapy in some cases

Patient Experience:

• During the procedure: Under anesthesia, minimal awareness or discomfort
• Post-procedure: Expect discomfort or pain at both donor and recipient sites, managed with medications
• Dressing changes and wound care are crucial for successful recovery
• Long-term: Patients may experience changes in sensation and appearance of both sites, typically lessening over time. Regular follow-ups ensure optimal healing.