Now that we have discussed some common adjacent tissue transfer techniques, let’s take a look at the codes themselves.
CPT CODE SOFT TISSUE MASS EXCISION FOOT SKIN
As a general rule, though, any technique that involves creating additional incisions to create flaps of tissue that include skin and/or subcutaneous tissues that are then advanced, rotated, or relocated in some manner to repair a defect could meet the definition of adjacent tissue transfer. There are some other less common techniques that might also fit the definition of adjacent tissue transfer like S-plasty, H-plasty, etc. Here is a visual for this type of flap: Advancement Flap Advancement Flaps: An adjacent tissue transfer technique where incisions are made to create a flap that slides or “advances” forward from its normal location into a defect for repair.The flap receives blood flow from the donor site where the flap is created and is then moved over or under other tissues to reach the defect needing repair. This island flap receives its blood supply from random non-dominant blood vessels in the subdermal plexus which is where the term “random” island flap comes in. Random Island Flap: An adjacent tissue transfer technique that involves creation of a flap where the skin is divided all the way around the flap (the incisions completely surround the flap much like water completely surrounds an island which is where this technique gets its name).Here is a visual for this technique: Rotation Flap Rotation flap: An adjacent tissue transfer technique where additional incisions are made to create a flap next to a defect that is then “rotated” over the defect to repair it.Again if you are more of a visual learner, here’s a picture showing the “V” portion of the technique in designing the flap and the “Y” portion of the technique in advancing and suturing the flap into place over the defect: V-Y Plasty. The final repair which includes a straight line of sutures to repair the area where the flap came from and two additional lines of sutures to sew in the advancement flap in the defect looks like the letter Y which is where this technique “V-Y plasty” gets its name. V-Y plasty: An adjacent tissue transfer technique where incisions are made in a shape resembling the letter V to create a flap that is then advanced (moved from one position to another) to repair a defect.If you are having trouble picturing what a W-plasty or Z-plasty looks like, check out this link with a great picture of each technique (I’m a visual learner so, for me, pictures are worth a thousand words): W and Z plasty These additional incisions create flaps of tissue that are then sutured together to repair the wound. Z-plasty: An adjacent tissue transfer technique where additional incisions are made on either side of a wound creating a shape that resembles the letter Z.W-plasty: An adjacent tissue transfer technique where additional incisions in the shape of the letter W are made along the edges of the wound to reduce tension on the edges of the wound and create some laxity in the tissue that allows the wound edges to come together to repair the wound.Some examples of adjacent tissue transfer include the following techniques: The “defect” repaired may be a traumatic wound/injury or may be a defect left after excision of a lesion/mass. Adjacent tissue transfer involves rearranging/transferring local areas of the skin along with the underlying subcutaneous tissues to repair a defect.