Amputation, leg, through tibia and fibula; secondary closure or scar revision
CPT4 code
Name of the Procedure:
Amputation, leg, through tibia and fibula; secondary closure or scar revision
Summary
In this surgical procedure, the leg is amputated through the tibia and fibula bones. Secondary closure or scar revision may be performed to improve the healing of the amputation site or to address any existing scars.
Purpose
This procedure addresses severe trauma, infection, poor circulation, or other medical conditions that affect the lower leg. The primary goal is to remove damaged or diseased tissue to save the patient’s life or improve their overall health and quality of life.
Indications
- Severe traumatic injury to the lower leg
- Unmanageable infections, such as osteomyelitis
- Critical limb ischemia or poor circulation not responding to other treatments
- Non-healing diabetic ulcers or gangrene
- Bone cancer or aggressive tumors of the lower leg
Preparation
- Fasting usually required 6-12 hours before surgery.
- Adjustments in medications, such as blood thinners, may be needed.
- Pre-surgery assessments may include blood tests, imaging studies (like X-rays or MRIs), and evaluations by the surgical team.
Procedure Description
- Anesthesia: General or regional anesthesia will be administered to ensure the patient is pain-free.
- Incision: A surgical incision is made through the skin and muscles of the lower leg.
- Bone Cutting: The tibia and fibula bones are cut at the specified level.
- Tissue Management: Care is taken to preserve as much healthy tissue, muscle, and skin as possible for flap creation.
- Hemostasis: Blood vessels are tied off to prevent bleeding.
- Secondary Closure: The skin flaps are used to close the wound, sometimes with adjustments to scar tissue for better healing.
- Sutures/Clips: Surgical staples or sutures are used to close the incision.
Duration
The procedure typically takes 1-3 hours, depending on its complexity and the need for scar revision.
Setting
The procedure is typically performed in a hospital operating room.
Personnel
- Surgeon (orthopedic or vascular)
- Anesthesiologist
- Surgical nurse
- Operating room technician
Risks and Complications
- Infection
- Bleeding
- Blood clots
- Phantom limb pain
- Poor wound healing or dehiscence
- Need for further surgery or revisions
Benefits
- Removal of diseased or non-viable tissue
- Reduced pain and infection risk
- Potential for improved mobility with a prosthetic limb
- Improved overall health and quality of life
Recovery
- Hospital stay of several days following surgery
- Pain management with medication
- Physical therapy for strength and mobility training
- Wound care instructions to follow at home
- Follow-up appointments to monitor healing
Alternatives
- Revascularization surgery for improving limb blood flow
- Advanced wound care techniques
- Hyperbaric oxygen therapy (for some infections)
- In some cases, partial amputation may be an option
Patient Experience
Patients can expect to be under anesthesia during the procedure, so sensations are not felt during surgery. Post-surgery, they may experience pain or discomfort managed with medications. Emotional and psychological support is often needed as patients adjust to the loss of a limb. The healthcare team provides extensive support for pain management, rehabilitation, and adaptation to a prosthetic limb, if appropriate.