In the Burn Unit where I work most grafts that are 8% would be outpatient. The donor skin comes from the patient usually the thigh (or back depending on how much skin is required) and is meshed so only a small area has to be taken. After the burn is debrided the donor skin is applied by using staples to keep it intact. A post-op dressing is applied which is usually tegaderm on the donor site and xeroform and the grafts and a lot of padding. The dressing is removed within 3 days and stapples come out 4-5 days depending on how the graft is healing. The donor site is basically like a second degree burn and most say it is more painful than the graft. It usually heals within 2-4 weeks if there aren't any complications. As for the Medicaid, they should pay. The doctors I work with are Plastic Surgeons but they specialize in burns, if Medicaid is refusing to pay the doctor can appeal to them. The doctor should be experienced in grafting burns and the care afterwards because it is a long and painful process. He may require PT or OT and will need to be monitored for scarring in the future. As for pain we usually start the patient out on Vicodin and if this doesn't help then we try different methods (as outpatient our docotors would prescribe Dilaudid 2mg.)
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