Wiki Cross-finger flap with split thickness skin graft


Rothbury, MI
Best answers
Please help! I am not sure if I should code 15574 or 14350 for the cross finger flap and 15100 for the graft?

Amputation of tip of right long finger with exposed distal phalanx.

Cross-finger flap from right ring finger to right long finger and
split-thickness skin graft from right volar forearm to cover defect on right
ring finger.

Patient is a 29-year-old male, who suffered a saw injury to his right long
finger who presents with exposed distal phalanx.

Patient was taken to the operating room on 03/05, where he was first given
general anesthetic. Next, his forearm, arm, and hand were prepped and draped
in normal sterile fashion. Next, his arm was elevated, exsanguinated with
Esmarch bandage, tourniquet inflated to 250 mmHg. Attention was then directed
toward cleaning up the wound. At the distal phalanx, I removed a small portion
of the nail matrix and used a rongeur to make the bone even with the nail
matrix. I then used a rasp to smooth out the bone. Then debrided some of the
soft tissue. It was clear that he did not have enough volar tissue to provide
coverage over the bone. At this point, I elected to do a cross-finger flap,
which I discussed with the patient previously. The flap was designed based on
the ring finger. The rectangular-type incision was made over the dorsal aspect
of the ring finger, elevating the skin flap, but leaving enough peritenon on
the extensor tendon to allow for skin graft to heal. Once the flap was
elevated, I then harvested a split-thickness skin graft using a Zimmer
dermatome set of an inch from the volar ulnar aspect of his
forearm just distal to the antecubital fossa. I then trimmed the skin graft to
the appropriate size, sutured in place using 5-0 nylon as both sutures in
running 5.0 chromic around the perimeter of the graft. Once the graft was sewn
in, I tied bolster of cotton balls and mineral oil over the cotton balls,
Xeroform and mineral oil over the graft to secured in position. Once that was
done, I then sewed the elevated cross-finger flap to the defect on the volar
aspect of the long finger using interrupted 5-0 nylon sutures. Once that was
done, I then released the tourniquet. Once the flap perfuse nicely, no sign of
vascular compromise, I then dressed the wounds with bulky soft
bandage and splint both dorsally and volarly to hold the hand in an acceptable
position to allow for flap take. He tolerated the procedure well and was sent
to discharge area in stable condition.