Name of the Procedure:

Full Thickness Graft, Free, Including Direct Closure of Donor Site, Trunk; Each Additional 20 sq cm, or Part Thereof (List Separately in Addition to Code for Primary Procedure)

Summary

A full-thickness graft involves taking a patch of skin that includes all layers of the skin (epidermis and dermis) from one part of the body (donor site) and transplanting it to another area that has lost skin due to injury, surgery, or disease. This specific procedure focuses on grafts taken from the trunk with direct closure of the donor site.

Purpose

Full-thickness skin grafts are used to repair and cover areas where significant skin loss has occurred, providing a protective barrier, reducing the risk of infection, and promoting healing. It is often employed to treat wounds, burns, or sites of surgical excision.

Indications

• Extensive skin loss from injuries, burns, surgical procedures, or chronic wounds.
• Areas requiring durable and aesthetically similar skin patches for better functional and cosmetic outcomes.
• Patients needing skin replacement for better movement and less contraction, especially in joint areas.

Preparation

• Patients may need to fast for several hours before the procedure if general anesthesia is used.
• Pre-operative assessments typically include blood tests, medical history review, and possibly imaging studies.
• Patients should discuss all medications they are taking with their surgeon, as some may need to be stopped or adjusted beforehand.

Procedure Description

1. The surgeon selects and preps the donor site on the trunk where healthy skin will be taken.
2. Under anesthesia, a full-thickness section of skin is excised from the donor area.
3. The donor site is then directly closed with sutures.
4. The excised skin is meticulously positioned on the recipient site and secured with stitches, staples, or adhesive.
5. Dressings are applied to both the donor and graft sites to protect them and encourage healing.

Duration

The procedure typically lasts between 1 to 2 hours, depending on the size and complexity.

Setting

This procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• A surgical team led by a plastic or reconstructive surgeon.
• Anesthesia provider (anesthesiologist or nurse anesthetist).
• Surgical nurses and technicians.

Risks and Complications

• Common: infection, bleeding, pain, swelling.
• Less common: graft failure, scarring, donor site complications, allergic reactions to anesthesia.
• Rare: tissue necrosis, ulceration, keloid formation.

Benefits

• Provides robust skin coverage, especially for deeper or more complex wounds.
• Typically results in better functional and cosmetic outcomes compared to other types of skin grafts.
• Can significantly improve the patient's quality of life by restoring skin integrity and appearance.

Recovery

• Patients are usually monitored post-operatively in a recovery room.
• Instructions include keeping the graft area clean and immobile, monitoring for signs of infection, and attending follow-up appointments.
• Recovery time varies; most patients can return to normal activities within a few weeks, but strenuous activities should be avoided until cleared by the surgeon.

Alternatives

• Split-thickness skin grafts.
• Skin substitutes or synthetic grafts.

• Local tissue flaps.

  Pros and cons should be discussed with the surgeon, as each alternative has different implications for recovery, outcomes, and risk of complications.

Patient Experience

Patients may feel discomfort or pain at both the donor and graft sites, which can be managed with pain medications. Initial immobility of the graft site is usually recommended to ensure successful take of the graft. Patients are typically instructed on wound care and signs of complications to watch for during recovery.