CPT® Code 20973

A free osteocutaneous flap is a surgical procedure utilized to address complex defects involving both soft tissue and bone. This technique is particularly important in reconstructive surgery, where the goal is to restore both the aesthetic and functional aspects of the affected area. The procedure involves the careful harvesting of a flap that includes skin, subcutaneous tissue, and bone from a donor site, which in this case is the great toe with web space. The process begins with the measurement of the defect that needs repair, followed by the determination of the dimensions of the cutaneous portion of the flap. Surgeons meticulously draw incision lines on the skin at the donor site, ensuring precision in the harvesting process. Once the incision is made, the skin is dissected from the underlying tissues while preserving the vascular pedicle, which is crucial for maintaining blood supply to the flap. The underlying musculature is then exposed, and care is taken to preserve the associated blood vessels and nerves. The bone that will be harvested is also exposed, and the surgeon carefully determines the amount needed to fill the bony defect. After harvesting the osteocutaneous flap, which includes intact vascular structures, it is transferred to the recipient site where the defect is located. The bone is positioned within the bony defect and secured in place, while the vascular structures of the flap are anastomosed to the blood vessels at the recipient site using microvascular techniques. Finally, the skin portion of the flap is positioned in the defect and secured with sutures, completing the reconstruction. The donor site may be closed with sutures, or alternatively, a separately reportable skin graft may be utilized to repair the donor site. This procedure is essential for restoring function and appearance in areas affected by significant tissue loss or damage.