Name of the Procedure:

Full Thickness Graft, Free, including Direct Closure of Donor Site, Nose, Ears, Eyelids, and/or Lips; 20 sq cm or less
(Also known as Full Thickness Skin Graft (FTSG), Free Tissue Transfer)

Summary

A full thickness graft is a surgical procedure where a piece of healthy skin is completely removed from a donor site and transplanted to a recipient site. The donor site is directly closed after the skin is taken. This specific procedure targets small areas (20 square centimeters or less) on the nose, ears, eyelids, or lips.

Purpose

The full thickness graft is used to repair skin defects caused by injury, surgery, or disease. It aims to restore the appearance and function of the affected area by replacing damaged skin with healthy skin from another part of the body.

Indications

• Severe skin damage due to burns, trauma, or surgery
• Areas needing skin coverage where there is a high requirement for a good cosmetic outcome, such as the face
• Recurrent skin cancer removal sites
• Scars or non-healing wounds

Preparation

• Patients may need to fast if general anesthesia is planned.
• Medications that increase bleeding risk, such as blood thinners, should be adjusted as advised by your doctor.
• Diagnostic tests like blood work or imaging studies may be required to ensure the patient's readiness for surgery.

Procedure Description

1. Anesthesia: The patient is administered local or general anesthesia based on the case specifics.
2. Donor Site Harvesting: A small piece of skin is removed from a donor site, often behind the ear, the upper hip, or another inconspicuous area.
3. Recipient Site Preparation: The damaged or defective skin is removed from the affected area.
4. Graft Placement: The harvested skin is carefully placed over the recipient site and sutured into place.
5. Closure: The donor site is then directly closed with sutures.
6. Dressing: Both sites are dressed appropriately to aid in healing and minimize infection risks.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and size of the area being treated.

Setting

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

Personnel

• Surgeon (specializing in plastics or dermatology)
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)
• Surgical assistant

Risks and Complications

• Infection
• Blood loss
• Graft failure or rejection
• Scarring at both donor and recipient sites
• Temporary or permanent changes in skin sensation
• Poor cosmetic outcome

Benefits

• Improved appearance and function of the affected area
• Restoration of healthier skin
• Quick recovery for small grafts

Recovery

• Keep the graft site clean and follow proper wound care instructions.
• Avoid strenuous activity and stretching the graft area until it is well-healed.
• Follow-up appointments will be scheduled to monitor healing.
• Typical recovery can take a few weeks, but return to normal activities usually occurs within 1-2 weeks.

Alternatives

• Split-thickness skin grafts
• Local flap surgery
• Synthetic skin substitutes
• Healing by secondary intention (allowing the wound to heal on its own)

Each alternative has its benefits and drawbacks, primarily concerning cosmetic outcome, donor site morbidity, and healing time.

Patient Experience

• Local anesthesia will numb the involved areas, though some discomfort might be felt.
• Post-procedure, patients may experience mild to moderate pain, managed by prescribed pain medications.
• Some swelling and bruising are common in the first few days.
• Most patients find the discomfort resolves within a week or two.