Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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 (Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands, and/or Feet); Each Additional 20 sq cm, or Part Thereof
Summary
A full thickness graft involves taking a complete layer of skin from a donor site on the patient's body and transplanting it to an area where skin is missing or damaged. This particular procedure not only covers the primary graft but also any additional 20 square centimeters required, and it includes the closure of the donor site.
Purpose
This procedure addresses significant skin loss or damage due to injury, burns, ulcers, or surgical removal of cancerous tissues. The goal is to restore the skin's integrity, function, and appearance in the affected area.
Indications
- Severe skin damage or loss
- Chronic, non-healing ulcers
- Large wounds or burns
- Post-tumor excision reconstruction
- Conditions that prevent simple wound closure
Preparation
- Patients may be instructed to fast for a certain period before the procedure.
- Blood tests and skin assessments are typically required.
- Adjustments in medication, particularly blood thinners, may be necessary.
Procedure Description
- Anesthesia is administered to ensure the patient is comfortable and pain-free.
- A donor site is selected, usually from an area with ample skin like the thigh or buttocks.
- A full thickness of skin is harvested from the donor site.
- The harvested skin is transplanted to the damaged area, and meticulous stitching is done to secure it.
- Direct closure of the donor site is performed to promote healing.
Tools and equipment include scalpels, sutures, and sterilized dressing materials.
Duration
The procedure typically takes 1-3 hours, depending on the size of the area being grafted.
Setting
Performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeons specialized in reconstructive or plastic surgery
- Anesthesiologists
- Surgical nurses and assistants
Risks and Complications
- Infection
- Graft rejection or failure
- Scarring
- Donor site complications
- Bleeding or hematoma formation
Benefits
- Restoration of skin function and appearance
- Improved wound healing
- Reduction in pain and discomfort related to open wounds or ulcers
Recovery
- Patients may need to stay overnight in the hospital for observation.
- Post-procedure care includes keeping the graft and donor sites clean and avoiding strenuous activities.
- Follow-up appointments are crucial for monitoring graft acceptance and healing.
Alternatives
- Split-thickness grafts: Less skin is taken, faster donor site recovery but less durable.
- Skin flaps: Nearby tissue is used, requiring less surgical intrusion.
- Negative pressure wound therapy: Promotes healing by using suction.
Pros and cons depend on the specific condition, size, and location of the wound.
Patient Experience
Patients may experience initial discomfort and swelling, managed with pain medications. Confined activities and specific aftercare instructions are necessary to ensure optimal healing. Full recovery and adjustment to normal activities can take several weeks to a few months.