Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis tendon), complete amputation
CPT4 code
Name of the Procedure:
Replantation of a Digit (excluding thumb, includes metacarpophalangeal joint to insertion of flexor sublimis tendon), Complete Amputation
Summary
Replantation of a finger (excluding the thumb) involves surgically reattaching a completely amputated finger back to the hand. This complex procedure aims to restore as much function and appearance as possible.
Purpose
The primary goal is to reattach and restore function to the amputated finger. This procedure is performed to enable the patient to regain sensation, motor function, and a more natural appearance in the affected hand.
Indications
- Complete amputation of a finger (excluding the thumb)
- Amputation that occurs from the metacarpophalangeal joint to the insertion of the flexor sublimis tendon
- Patient is in good health with viable tissue available for reattachment
- Immediate availability of surgical and postoperative care
Preparation
- Fast for 8 hours before the procedure if general anesthesia will be used
- Notify the surgeon of any medications, allergies, or existing health conditions
- Removal of any jewelry or tight clothing from the affected hand
- Diagnostic tests such as X-rays or vascular studies to assess the condition of the amputated part and surrounding structures
Procedure Description
- The patient is usually placed under general anesthesia.
- The amputated digit and the hand are meticulously cleaned and disinfected.
- The surgeon identifies and aligns blood vessels, nerves, tendons, and bones.
- Microvascular surgical techniques are used to reconnect arteries and veins.
- The bones may be fixed with wires or small plates and screws.
- Tendons and muscles are repaired to restore movement.
- Skin and soft tissue are closed with fine sutures.
Duration
The procedure typically takes 6 to 12 hours, depending on the complexity of the injury.
Setting
The procedure is performed in a hospital operating room, equipped with a surgical microscope and specialized instruments for microsurgery.
Personnel
- Orthopedic or plastic surgeon specializing in microsurgery
- Anesthesiologist
- Surgical nurse
- Scrub technician
- Postoperative care team
Risks and Complications
- Infection
- Blood clotting
- Failed reattachment (non-viable tissue)
- Reduced range of motion or function
- Cold sensitivity in the replanted finger
- Nerve damage leading to sensory issues
Benefits
- Restoration of finger function which includes gripping, holding, and other fine motor activities
- Improved hand appearance
- Any benefits can begin to be realized within a few weeks to months post-procedure, with continued improvements over time.
Recovery
- Carefully follow pain management guidelines provided by the healthcare team
- Immobilization of the hand and finger with a splint or cast
- Gradual rehabilitation and physical therapy to restore movement and strength
- Routine follow-up appointments for assessment and potential adjustments to care plan
- Full recovery may take several months to a year, with ongoing physical therapy required
Alternatives
- Prosthetic fingers: Ergonomically designed but lack sensory function
- Revision amputation: Where the remaining part of the digit is surgically refined for better healing and the fitting of a prosthesis
- Specialized adaptive tools and rehabilitation programs
Patient Experience
During the procedure, the patient will be under anesthesia and feel no pain. Postoperatively, the patient can expect some pain and swelling, managed with prescribed medications. Physical therapy will be necessary, and the hand will initially need to be immobilized to ensure proper healing. Complete recovery and maximum functionality restoration will require patience and adherence to the rehabilitation program.