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what is an adjacent tissue transfer flap

by Hortense Powlowski Published 1 year ago Updated 2 months ago

An adjacent tissue transfer (CPT® 14000-14350) relocates a flap of healthy skin from a donor site to an adjacent laceration, scar, or other discontinuity. A portion of the flap is left intact to supply blood to the grafted area.

Is adjacent tissue transfer same as flap?

The donor site is the same body part, with the flap being taken from the area adjacent to the skin defect that has to be covered up. The main advantage of an adjacent tissue transfer over skin or tissue graft is that a part of the flap remains connected to its origin.

What is an adjacent skin graft?

Conclusion: Adjacent-tissue skin grafts provide a suitable reconstruction option for surgical defects too large for simpler repair or defects crossing cosmetic units or near free margins. This procedure permits repair with a full-thickness skin graft of more similar skin characteristics to the recipient site.

What is the difference between a skin graft and a flap?

What's the difference between a graft and a flap? A graft is just the skin without a blood supply, whereas a flap is transferred with its blood supply intact. With a flap, larger amounts of tissue can be used, including muscle if required.

What is included with an adjacent tissue transfer or rearrangement?

Adjacent tissue transfer or rearrangement procedures include excision (CPT codes 11400-11646) and repair (12001-13160). Thus, CPT codes 11400-11646 and 12001-13160 shall not be reported separately with CPT codes 14000-14350 for the same lesion or injury.

Is a skin flap better than a skin graft?

Skin flaps are thought to provide better cosmetic results than skin grafting (Fig.

How long does skin flap take to heal?

It may take up to 2 weeks to heal, but it can take longer. Your surgeon will discuss this with you. The donor site can often feel more uncomfortable than the grafted area. You may need to take regular pain relief for a while.

How painful is flap procedure?

Right after the surgery, you will probably feel weak, and you may feel pain for 2 to 3 weeks. You will be sore in the breast and in the area where the flap was taken. You may have a pulling or stretching feeling in those areas.

What are the risks of flap surgery?

Blood vessels supplying the flap may kink or get clots, leading to bleeding and a loss of circulation. This may cause the tissue to die, leading to a partial or complete loss of the flap. This is more common in women who smoke or have recently quit. Quitting before surgery will help you to decrease the risk.

Is flap surgery painful?

Most patients experience some discomfort after a flap procedure. Depending on your needs, we may prescribe pain medication or recommend over-the-counter medicine. It is important to relax after surgery, as strenuous activity may cause the treated area to bleed.

How do you determine the size of adjacent tissue transfer?

If the adjacent tissue transfer closed both the primary defect and the secondary defect, add both the size of primary defect plus the size of the secondary defect to determine the size of the flap that is coded.

What is a muscle flap procedure?

Flap surgery involves transporting healthy, live tissue from one location of the body to another - often to areas that have lost skin, fat, muscle movement, and/or skeletal support.

How should you code an excision of a lesion when completed with an adjacent tissue transfer?

Answer: The lesion excision is included with the ATT (adjacent tissue transfer). When adjacent tissue transfer or rearrangement is performed in conjunction with excision of a lesion, the lesion excision is not reported separately. You would report only the ATT (14020).

What are the 4 types of skin grafts?

Depending on the origin:Autograft or autologous graft: skin obtained from the patient's own donor site.Allograft or heterologous graft: skin obtained from another person.Xenograft or heterograft: skin from other species, such as pigs.Synthetic skin substitutes: manufactured products that work as skin equivalents.

What are the 2 types of skin grafts?

Split-thickness skin grafts (STSG) are composed of the epidermis and a superficial part of the dermis. Full-thickness skin grafts (FTSG) contain both the full epidermis and dermis.

What are the three types of grafts?

According to their origin, skin grafts can be divided in 3: Autografts, allografts and xenografts. Autografts are taken from the patient's own skin, and they are the most common used skin grafts. Allografts come from another person's skin.

What are the four types of graft?

Several different methods are commonly used for grafting plants. These include cleft grafting, inlay grafting, four-flap grafting, and whip grafting.

What is adjacent tissue transfer?

Adjacent tissue transfer involves rearranging/transferring local areas of the skin along with the underlying subcutaneous tissues to repair a defect. The “defect” repaired may be a traumatic wound/injury or may be a defect left after excision of a lesion/mass. Some examples of adjacent tissue transfer include the following techniques:

How many square centimeters is adjacent tissue transfer?

For adjacent tissue transfer of the eyelids, nose, ears and/or lips, when the area repaired by adjacent tissue transfer is 30 square centimeters or less, assign one of the following codes:

What is advancement flap?

Advancement Flaps: An adjacent tissue transfer technique where incisions are made to create a flap that slides or “advances” forward from its normal location into a defect for repair. Here is a visual for this type of flap: Advancement Flap

How big is a defect in tissue transfer?

Once the defect being repaired with adjacent tissue transfer reaches an area of 30.1 sq cm or larger, instead of reporting the codes we have discussed above that are specific for different anatomic sites, we have special codes that are reported for “any area” larger than 30 sq cm.

What is the W-plasty technique?

W-plasty: An adjacent tissue transfer technique where additional incisions in the shape of the letter W are made along the edges of the wound to reduce tension on the edges of the wound and create some laxity in the tissue that allows the wound edges to come together to repair the wound.

What is a random island flap?

This island flap receives its blood supply from random non-dominant blood vessels in the subdermal plexus which is where the term “random” island flap comes in. The flap receives blood flow from the donor site where the flap is created and is then moved over or under other tissues to reach the defect needing repair.

What is Z-plasty?

Z-plasty: An adjacent tissue transfer technique where additional incisions are made on either side of a wound creating a shape that resembles the letter Z. These additional incisions create flaps of tissue that are then sutured together to repair the wound.

Check location and combined areas to capture separately reportable procedures

By Ken Camilleis, CPC, CPC-I, CMRS An adjacent tissue transfer (CPT ® 14000-14350) relocates a flap of healthy skin from a donor site to an adjacent laceration, scar, or other discontinuity. A portion of the flap is left intact to supply blood to the grafted area.

Include Same-location Excision, Debridement, and Repairs

Per CPT ® instructions, ATT/R procedures include excisions at the same location—for instance, to revise a scar or to remove a benign or malignant lesion. CPT® Assistant (July 2008) provides the following example: A physician excises a 1.5 cm lesion on the cheek with an excised diameter of 1.8 cm (primary defect, approximately 3.2 sq cm) and performs an adjacent tissue transfer (flap dimension of 1.4 cm x 3.0 cm, which equals a 4.2 sq cm secondary defect).

Grafts Call for Separate Coding

As CPT® Assistant (July 2008) explains, “Sometimes a tissue transfer or rearrangement procedure creates an additional defect that must be repaired.

How does a pedicle flap surgery work?

For a pedicle flap reconstruction surgery, your surgeon moves tissue under your skin to your breast area without disconnecting it completely from the donor site.

What to do if you have a free flap reconstruction?

A blood thinner. If you had a free-flap reconstruction, you may get an injection (shot) of a blood thinner. Blood thinners keep your body from forming blood clots in the surgical area.

When to put on bra or gauze pad?

If your surgeon told you to wear a bra or cover your incision with a gauze pad, put on the bra or gauze pad after you finish checking your incisions and drain sites.


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