Exploring The Potential Of Acellular Dermis Grafts For Wound Healing And Soft Tissue Repair

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Author(s): 
J. Palmer Branch, DPM, FACFAS

Key Pointers On Joint Resurfacing And Using Grafts As Joint Spacers

Several authors have described techniques of using acellular dermis grafts in a joint resurfacing application.11 The degenerated articular cartilage is removed and the graft is then placed over the subchondral bone (typically left intact). The graft material acts as an anatomic spacer. Techniques and cases have focused on the first metatarsophalangeal joint with a series of patients showing good long-term success.11 This new area of application would seem to warrant more long-term studies to determine the durability and subsequent incorporation of the grafts, as well as ultimate success in achieving long-term pain relief.

Case Study: Abscess With Extensive Soft Tissue Defect

A 42-year-old female with new-onset diabetes presented with a large abscess encompassing almost the entire dorsal aspect of her left foot and a gangrenous fourth toe. After an appropriately aggressive incision and drainage including fourth toe amputation, administration of intravenous antibiotics and local wound care, the wound was adequately clean and viable. (Picture 10).

The size of the wound as well as the exposed tendon and bone put the wound at significant risk for infection or failure to heal if allowed to heal by secondary intention alone. I decided to apply an acellular dermis graft to facilitate healing.

   I debrided the wound and flushed it with a pulse lavage in the operating room. (Picture 11) I placed absorbable calcium sulfate beads with vancomycin. I meshed a 5 x 10 cm Bacterin hMatrix® acellular dermis graft and placed it on the wound. (Picture 12) A VAC® device facilitated healing. The wound was granulated well through the graft over time. (Pictures 13, 14) Sequential applications of Dermagraft then stimulated epithelialization. (Pictures 15-17)

How To Code For Acellular Dermis Graft Procedures

Surgical procedure codes frequently change and are expected to be overhauled if and when the final release and implementation of ICD-10 codes occurs.24,25 At the time of the submission of this article for publication in 2012, the following coding suggestions were felt to be most applicable by this author. Individual insurance payor guidelines may vary. Most procedures (except debridements) have a 90-day global period.

Supply code for acellular dermis graft – Q4107 per square cm

Wound prep of ulcer for graft application
(* specify by surface area/location)
15000 – 15004 (depending on payer guidelines)
Vs. Standard ulcer debridement codes – 11042-11044

Applying The Graft To Wounds

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