15574 Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet

Name of the Procedure:

Formation of Direct or Tubed Pedicle, with or without Transfer; Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands or Feet

Summary

The procedure involves creating a direct or tubed pedicle, a technique used in reconstructive surgery to transfer skin and underlying tissues from one part of the body to another. This method helps repair defects or deformities due to trauma, surgery, or congenital conditions. The pedicle remains attached to its original blood supply during the process.

Purpose

The primary aim is to reconstruct areas with significant tissue loss or damage, restoring both function and appearance. It is often used in critical areas like the face, hands, and genitalia where both aesthetics and function are paramount.

Indications

• Extensive tissue loss due to trauma or injury.
• Defects following cancer surgery (e.g., after tumor removal).
• Congenital deformities requiring correction.
• Chronic non-healing wounds.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Medication adjustments, such as stopping blood thinners, may be necessary.
• Pre-operative imaging or blood tests to assess overall health.

Procedure Description

1. Preparation: The patient is placed under anesthesia.
2. Marking and Planning: The surgeon marks the donor and recipient sites.
3. Incision and Pedicle Formation: An incision is made, and a flap of skin with its underlying tissues (including blood vessels) is carefully lifted.
4. Tubed Pedicle (if applicable): The flap is shaped into a tube to protect the blood supply.
5. Attachment: The flap is moved to the defect site while keeping the blood supply intact.
6. Closure: Both donor and recipient sites are closed with sutures.

Tools and Equipment

• Surgical scissors and scalpels.
• Sutures and needles.
• Sterile drapes and surgical gowns.

Anesthesia

General anesthesia is typically used to ensure the patient is completely unconscious and pain-free.

Duration

The procedure can take several hours, depending on the extent and complexity of the reconstruction.

Setting

Performed in a hospital operating room or specialized surgical center with full medical facilities.

Personnel

• Reconstructive Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection at the donor or recipient site.
• Poor wound healing or tissue necrosis.
• Bleeding or hematoma.
• Scarring or changes in skin sensation.
• Possible need for additional surgeries.

Benefits

• Significant improvement in the appearance and function of the affected area.
• Enhanced quality of life and self-esteem.
• Restoration of critical functions such as speech or hand movements.

Recovery

• Hospital stay for a few days post-surgery.
• Instructions on wound care and activity restrictions.
• Follow-up visits to monitor healing.
• Recovery time varies but usually spans several weeks to months.

Alternatives

• Skin grafts (using skin without the underlying tissue) – less complex but may not be as durable.
• Microsurgical free flap – intricate and requires reattaching blood vessels.
• Synthetic grafts or tissue engineering – emerging fields with varying success rates.

Patient Experience

• Initial discomfort and pain managed with medication.
• Swelling and bruising common in the immediate post-operative period.
• Gradual improvements in appearance and function.
• Emotional and psychological support may be necessary due to the impact on body image.