15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

CPT 15260 describes the surgical procedure of harvesting and applying a full-thickness skin graft (FTSG) to a recipient site located on the nose, ears, eyelids, or lips, covering an area of 20 square centimeters or less. Unlike split-thickness grafts, which only include the epidermis and a portion of the dermis, a full-thickness graft includes the entire epidermis and the full thickness of the dermis. This technique is clinically preferred for facial reconstruction because full-thickness grafts undergo less secondary contraction and provide a superior cosmetic match in terms of color, texture, and thickness compared to thinner grafts. The procedure begins with the preparation of the recipient bed, ensuring it is free of necrotic tissue and has a healthy vascular supply capable of supporting the graft via plasmatic imbibition and subsequent inosculation. A donor site is selected—commonly the postauricular area, the supraclavicular fossa, or the upper inner arm—where the skin's characteristics closely resemble the recipient site. The surgeon harvests the skin to the level of the subcutaneous fat. A critical component of this code is that the direct closure of the donor site is included in the procedural package and should not be reported separately. Once harvested, the graft is meticulously 'defatted' to remove all subcutaneous adipose tissue, which would otherwise act as a barrier to revascularization. The graft is then tailored to fit the defect precisely and sutured into place. Often, a bolster or stent dressing is applied over the graft to maintain firm contact with the wound bed and prevent the formation of a hematoma or seroma, which are the most common causes of graft failure.

Clinical Indications

  • Reconstruction of surgical defects following the excision of malignant lesions (e.g., Basal Cell Carcinoma, Squamous Cell Carcinoma, Melanoma) on the nose, ears, eyelids, or lips.
  • Repair of traumatic tissue loss where primary closure or local flaps are not feasible or would cause significant distortion of facial features.
  • Correction of cicatricial ectropion of the eyelids resulting from scarring or previous surgery.
  • Reconstruction of the ear or nose following trauma or congenital deformity correction.
  • Release and coverage of burn contractures affecting the perioral or periorbital regions.

Procedure Steps

  1. Recipient Site Preparation: The wound bed is debrided and prepared to ensure a viable, vascularized surface.
  2. Template Creation: A sterile template (often using surgical gauze or foil) is made of the recipient defect to ensure accurate graft sizing.
  3. Donor Site Selection and Harvest: A suitable donor site is identified, and the full-thickness skin is incised following the template.
  4. Donor Site Closure: The donor site wound is closed primarily using standard surgical techniques (included in 15260).
  5. Graft Defatting: Subcutaneous fat is surgically removed from the underside of the graft using iris scissors until the dermal follicles are visible.
  6. Graft Fitting and Suture: The graft is placed onto the recipient bed and secured using fine, non-absorbable or absorbable sutures (e.g., 5-0 or 6-0 Prolene or Monocryl).
  7. Hemostasis: Meticulous control of bleeding at the recipient bed to prevent hematoma.
  8. Bolster Placement: A tie-over bolster dressing is frequently applied to provide uniform pressure and immobilization during the initial phase of graft 'take'.

Coding Guidelines

  • Code 15260 is specific to the nose, ears, eyelids, and/or lips. Use other codes in the 15200-15240 series for different anatomical locations.
  • The area measurement (20 sq cm or less) refers to the size of the recipient defect, not the donor site.
  • For grafts larger than 20 sq cm at these specific sites, use add-on code 15261 for each additional 20 sq cm or part thereof.
  • The excision of a lesion (e.g., 11640-11646) or the surgical preparation of a recipient site (15004-15005) may be reported separately if performed.
  • Repair of the donor site by local flap or specialized skin graft is NOT included and can be coded separately, but simple 'direct' closure is bundled into 15260.
  • Do not use 15260 for 'application' of skin substitutes; use the 15271-15278 series for those procedures.

Associated ICD-10 Codes