Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Full Thickness Graft, Free (including direct closure of donor site, scalp, arms, and/or legs); each additional 20 sq cm, or part thereof
Summary
A full thickness graft, free, involves removing a piece of skin, including all layers (epidermis and dermis), from a donor site and transplanting it to a different area that has lost skin. The donor site is then directly closed with sutures. This procedure is often an extension of a primary grafting procedure and covers additional areas of 20 square centimeters or part thereof.
Purpose
This procedure addresses skin loss due to burns, trauma, surgery, or chronic wounds. The goal is to restore the integrity of the skin, promote healing, and improve cosmetic and functional outcomes.
Indications
- Extensive burn injuries
- Large traumatic skin defects
- Chronic non-healing wounds
- Skin defects after surgical removal of lesions (e.g., cancer excision)
- Areas where other grafting methods (e.g., split-thickness grafts) are insufficient
Preparation
- Pre-procedure fasting as instructed by the healthcare provider
- Medications adjustments if necessary (e.g., blood thinners)
- Pre-operative consultation and consent
- Blood tests, imaging studies, or other assessments as needed
Procedure Description
- Anesthesia: The procedure typically begins with the administration of local or general anesthesia.
- Harvesting the Graft: The surgeon selects a donor site (scalp, arms, or legs) and removes a full thickness skin graft, which includes all layers of the skin.
- Preparing the Recipient Site: The recipient site is prepared by cleaning and removing any unhealthy tissue.
- Transplanting the Graft: The harvested skin graft is transplanted onto the recipient site and meticulously sutured into place.
- Closing the Donor Site: The donor site is then directly closed with sutures, minimizing the need for additional wound care.
Duration
The procedure typically takes 1-2 hours, depending on the size and complexity of the areas involved.
Setting
The procedure is usually performed in a hospital operating room or a surgical center.
Personnel
- Plastic or reconstructive surgeon
- Surgical nurses
- Anesthesiologist (if general anesthesia is used)
- Surgical technician
Risks and Complications
- Infection at the graft or donor site
- Graft failure or rejection
- Scarring at both donor and recipient sites
- Uneven skin texture or appearance
- Bleeding or hematoma formation
- Nerve damage
Benefits
- Restoration of skin integrity and appearance
- Improvement in wound healing
- Reduced risk of infection in chronic wounds
- Enhanced cosmetic results compared to other graft types
The benefits can typically be observed within a few weeks post-procedure.
Recovery
- Keep the graft and donor sites clean and dry
- Follow wound care instructions provided by the medical team
- Avoid strenuous activities for several weeks
- Attend follow-up appointments for monitoring and removal of sutures
Expected recovery time is usually 2-4 weeks, with additional time for complete healing.
Alternatives
- Split-thickness skin grafts: Involves only the epidermis and part of the dermis; less robust but simpler
- Synthetic skin substitutes: Useful for temporary coverage and healing
- Flap surgery: More complex but provides better blood supply and durability
Each alternative has its own pros and cons, and suitability depends on the specific patient condition.
Patient Experience
During the procedure, under local or general anesthesia, the patient should not feel pain. Post-procedure, there might be mild to moderate discomfort at both the donor and graft sites, managed with prescribed pain medications. Bruising, swelling, and tenderness are common but should subside within a few days to weeks. Proper wound care and follow-up visits are crucial for optimal healing and outcome.