CPT® Code 15170

Deleted

1. Indications

The acellular dermal replacement procedure is indicated for the treatment of skin defects located on the trunk, arms, or legs. This procedure is particularly suitable for patients who require a permanent solution for skin loss or damage due to various conditions. The following are specific indications for the use of acellular dermal replacement:

• Skin Defects The procedure is performed to cover significant skin defects resulting from trauma, surgical excisions, or congenital anomalies.
• Burns It is indicated for patients with burn injuries that have resulted in extensive skin loss, necessitating a durable replacement.
• Chronic Wounds The procedure may be utilized for chronic wounds that have not responded to conventional treatments, providing a new surface for healing.
• Skin Cancer Excision Following the excision of skin cancers, acellular dermal replacement can be used to reconstruct the affected area.

2. Procedure

The acellular dermal replacement procedure involves several critical steps to ensure effective application and healing. The following outlines the procedural steps:

• Preparation of the Wound Bed The first step involves preparing the wound bed by cleaning and debriding the area to remove any necrotic tissue and ensure a healthy surface for the acellular dermal replacement.
• Rinsing the Sheets Once the wound bed is prepared, the acellular dermal replacement sheets are removed from their packaging and rinsed in normal saline. This step is crucial for maintaining sterility and preparing the sheets for application.
• Meshing the Sheets After rinsing, the sheets are meshed to enhance their flexibility and adaptability to the contours of the wound bed, allowing for better integration with the surrounding tissue.
• Application of the Sheets The meshed sheets are then carefully placed over the prepared wound bed. It is essential to apply the sheets without overlapping them to ensure proper coverage and healing.
• Securing the Sheets The sheets are secured in place using interrupted sutures or staples, which help to maintain their position and promote adherence to the wound bed.
• Trimming Excess Material Any excess material at the periphery of the wound is trimmed to ensure a precise fit, which is important for optimal healing.
• Layered Dressing Application Following the placement of the acellular dermal replacement, a layered dressing is applied. This includes an elastic net fixation layer secured with staples, followed by an antimicrobial layer such as silver nitrate, a bulky layer of gauze, a compression layer, and an anti-shear layer to protect the wound and facilitate healing.

3. Post-Procedure

Post-procedure care is essential for ensuring proper healing and minimizing complications. After the application of the acellular dermal replacement, the patient should be monitored for any signs of infection or adverse reactions. The layered dressing should remain intact and be changed according to the healthcare provider's instructions. Patients may be advised to avoid excessive movement or pressure on the treated area to promote healing. Follow-up appointments are necessary to assess the healing process and determine if additional treatments or interventions are required. It is important to educate patients on signs of complications, such as increased redness, swelling, or drainage, which should prompt immediate medical attention.