Name of the Procedure:

Split-thickness Autograft for Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet, and/or Multiple Digits; Each Additional 100 sq cm, or Each Additional 1% of Body Area of Infants and Children

Summary

A split-thickness autograft involves taking a thin layer of skin from a donor site on the patient's body and transplanting it to an area where skin is damaged. This specific procedure covers delicate and highly sensitive areas such as the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and multiple digits, primarily for additional coverage in cases involving larger areas of skin damage, particularly in infants and children.

Purpose

This procedure is utilized to treat extensive skin damage or loss due to burns, trauma, infection, or surgical removal of diseased tissue. The goal is to promote healing, restore skin function, and improve the aesthetic appearance of the affected area.

Indications

• Severe burns or thermal injuries
• Extensive skin trauma or wounds
• Post-surgical skin defects (e.g., after tumor excision)
• Chronic, non-healing ulcers
• Large skin defects in infants and children requiring additional graft coverage

Preparation

• Fasting may be required if general anesthesia is used.
• Medications might need to be adjusted as advised by the healthcare provider.
• Pre-operative assessments including blood tests and imaging.
• Antiseptic cleansing of the donor and recipient sites.

Procedure Description

1. Anesthesia: Local, regional, or general anesthesia is administered based on the extent and location of the graft.
2. Harvesting: A dermatome (a special surgical instrument) is used to remove a thin layer of skin (0.012 to 0.018 inches thick) from a donor site, commonly the thigh or buttocks.
3. Preparation of the Recipient Site: The damaged area is cleaned and prepared to receive the graft.
4. Transplantation: The harvested skin is placed over the prepared site and secured using sutures or staples.
5. Dressing: The graft site is then covered with sterile dressings to protect it and promote healing.

Duration

The procedure typically takes about 1 to 3 hours, depending on the size and complexity of the graft.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Plastic or reconstructive surgeon
• Surgical nurse
• Anesthesiologist

Risks and Complications

• Infection at donor or recipient site
• Graft failure or rejection
• Scarring or disfigurement
• Sensation changes or numbness
• Pain at donor or recipient site
• Bleeding and hematoma

Benefits

• Facilitates healing and tissue regeneration
• Restores skin function and appearance
• Reduces hospital stay and overall recovery time
• Improves quality of life by restoring physical integrity

Recovery

• Post-procedure care involves keeping the graft and donor sites clean and dry.
• Regular follow-up appointments to monitor healing.
• Pain management with prescribed analgesics.
• Avoid strenuous activities or stretching the graft site.
• Recovery time varies, typically ranging from 2 to 4 weeks for initial healing, with complete recovery taking several months.

Alternatives

• Full-thickness skin grafts
• Skin substitutes or synthetic grafts
• Wound care and dressing techniques without grafting
• Pros: Full-thickness grafts may offer better aesthetic outcomes; synthetic grafts reduce the need for donor sites.
• Cons: Full-thickness grafts can be more invasive; synthetic options may not integrate as well or function as naturally as autografts.

Patient Experience

Patients may experience discomfort or pain during and after the procedure, managed by anesthesia during surgery and pain relievers afterward. Swelling, redness, and soreness at the graft and donor sites are common. Adherence to post-operative care instructions is crucial for optimal recovery and graft success.