Name of the Procedure:

Dermal 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

Summary

A dermal autograft is a surgical procedure that involves taking healthy skin from one part of the patient's body and transplanting it to a damaged or missing skin area on the face, scalp, eyelids, mouth, neck, ears, orbits (eye sockets), genitalia, hands, feet, or digits (fingers and toes). The procedure typically targets areas of skin damage up to 100 square centimeters or covers about 1% of the body area in infants and children.

Purpose

The procedural aim is to restore skin integrity and function in areas where skin has been lost or severely damaged, such as due to burns, trauma, surgery, infection, or congenital conditions. Expected outcomes include improved aesthetic appearance, functional recovery of the affected area, and prevention of complications like infection.

Indications

• Severe burns or thermal injuries
• Traumatic skin loss or injuries
• Surgical wounds requiring skin coverage
• Chronic non-healing wounds
• Skin infections resulting in tissue loss
• Congenital skin defects

Patients are typically considered for this procedure if conservative treatments are not sufficient, and healthy donor skin is available from another part of their body.

Preparation

• Pre-procedure fasting may be required if general anesthesia will be used.
• Medication management: certain medications might need to be stopped prior to surgery (e.g., blood thinners).
• Basic blood tests and diagnostic imaging to determine the extent of the damage and the viability of donor skin.
• Informed consent explaining the procedure, risks, and benefits.

Procedure Description

1. Anesthesia is administered (local or general, depending on the extent of the graft).
2. The donor site (usually an area with similar skin texture) is sterilized and a layer of skin is removed.
3. The recipient site is cleaned and prepped to receive the graft.
4. The graft is meticulously placed over the recipient site and secured using sutures, staples, or surgical adhesive.
5. Dressings are applied to both the donor and recipient sites to protect them.

Duration

The procedure typically takes 1 to 2 hours, but this can vary based on the size and complexity of the graft.

Setting

The procedure is performed in a hospital operating room or an outpatient surgical center, depending on the complexity and the patient's overall health.

Personnel

• Surgeons (usually a plastic or reconstructive surgeon)
• Surgical assistants
• Nurses
• Anesthesiologists (if general anesthesia is used)

Risks and Complications

• Infection at the donor or recipient site
• Graft rejection or failure
• Scarring or poor aesthetic outcome
• Pain at donor or recipient sites
• Bleeding or hematoma formation
• Sensory changes in the grafted area

Benefits

• Restoration of skin continuity and function
• Improved appearance and self-esteem
• Enhanced mobility and function in affected areas
• Reduced risk of infection or further tissue damage Results can begin to be seen in a few weeks, with long-term benefits realized as healing completes.

Recovery

• Follow-up appointments to monitor healing.
• Wound care instructions for both donor and graft sites, including keeping the areas clean and dry.
• Pain management guidance.
• Limited physical activity to avoid stressing the graft site. Full recovery typically takes several weeks to a few months.

Alternatives

• Split-thickness or full-thickness skin grafts from another donor (allografts).
• Skin substitutes or synthetic grafts.
• Negative pressure wound therapy. Pros and cons:
• Allografts and synthetic grafts may pose rejection risks and are less optimal than autografts.
• Skin substitutes may not integrate as well as autografts.

Patient Experience

Patients may experience discomfort or pain during and after the procedure, which is managed with pain medication. During recovery, there might be limited mobility and the need for diligent wound care. Emotional support and preparation for possible aesthetic changes are important aspects of overall care.