Wiki ReCell epithelial autograft

[colleen.rettig@carle.com]

Would you agree with 15002, 15003 x 19 and 15110 and 15111 x 19 for the procedure below? Does anybody have experience with ReCell epithelial autograft? Their website suggests 15110, 15111.
Thank you!

Pre procedure diagnosis: 13% TBSA partial thickness burn to face, left upper extremity and left lower extremity Post procedure diagnosis: 13% TBSA partial thickness burn to face, left upper extremity and left lower extremity Procedure: 1. Burn wound debridement to left calf of 720 sq cm, left upper extremity of 1000 sq cm and left hand of 200 sq cm 2. Preparation of donor site graft of 25 sq cm 3. Application of ReCell (epithelial autograft) of 720 sq cm to left calf, 1000 sq cm to left upper extremity, 200 sq cm to left hand and 25 sq cm to left donor site Anesthesia: GETA IVF: 2000 mL crystalloid EBL: Minimal Uop: 450 mL Specimen: None Complications: None Disposition: PACU Indication for procedure: 40 y.o. male with approximately 13% TBSA flame burn to face, left upper extremity, left lower extremity when trying to light gasoline. He initially presented to the emergency room and was sent home with local wound care. He presented to the clinic for follow up but due to poor pain control and evolution of the burn wound was sent to the emergency room for IV analgesia and further debridement. Wounds are partial thickness and the patient was a candidate for ReCell application for minimize wound care, facilitate recovery and healing and decrease pain and narcotic use. Risks including bleeding, infection, loss of graft, need for further excision and grafting, DVT, PE and MI were discussed and the patient voiced understanding and provided informed consent. Procedure: Patient brought to the operating room and placed in supine position. General anesthesia induced via endotracheal tube. Pre operative antibiotics administered. Corneal protectors placed with erythromycin ointment. Patient placed in right lateral decubitus position with the aid of a bean bag. Appropriate pressure points were padded. Left upper extremity, back, left thigh and lower extremity prepped and draped in standard sterile fashion. Time out performed to verify patient, procedure and laterality and everyone in the room was in agreement. Using the dermatome set at 0.008 a 25 sq cm donor skin graft was taken from the left lateral thigh. After skin removal hemostasis was obtained with epinephrine soaked telfa pad. Donor skin was used to prepare ReCell for epithelial autograft placement. From the 25 sq cm obtained, 1920 sq cm of ReCell (epithelial autograft) was prepared using the ReCell kit. Left calf, left upper extremity and back were debrided using the VersaJet hydrodebrider. This was done until eschar, pseudo eschar were removed to healthy punctate bleeding. In total 720 sq cm to the left calf, 1000 sq cm to the left upper extremity and 200 sq cm to the left hand were debrided to healthy tissue. There was no evidence for cellulitis or purulent drainage. Hemostasis was obtained with epinephrine soaked laparotomy pads. Once hemostasis was obtained, ReCell (epithelial autograft) was applied--720 sq cm to left calf, 1000 sq cm to left upper extremity, 200 sq cm to left hand and 25 sq cm to left thigh donor site. After application of ReCell area was covered with telfa clear. Left calf, left hand and left upper extremity were then dressed with xeroform, wrapped with kerlix and wrapped with coban. Care was taken to avoid a tight wrap and this was ensured with two fingers able to fit easily beneath the wrap. Donor site was dressed with telfa clear and Mepilex Ag and secured with Medipore tape. Over the left posterior back area was covered with Mepilex Ag and secured with Medipore tape. Patient was then placed supine and face cleaned of eschar using laparotomy pad. Corneal protectors were removed by anesthesia and eyes irrigated. All needle, lap and sponge counts were correct at the end of the case. Patient had straight catheterization performed by nursing and 450 mL was evacuated. Patient awoke from anesthesia without complication. Patient transferred to the PACU in stable condition.