28825 Amputation, toe; interphalangeal joint

Name of the Procedure:

Amputation, toe; interphalangeal joint (Commonly referred to as "Toe Amputation," "Interphalangeal Amputation")

Summary

A surgical procedure to remove one or more toes at the interphalangeal joint, which is the joint between the toe bones. This procedure may be performed due to severe infection, injury, or disease affecting the toe(s).

Purpose

The primary aim is to treat severe infections, gangrene, or traumatic injuries that cannot be healed or are causing significant health risks. The expected outcome includes removing the source of the infection or injury, preventing further complications, and improving the patient's quality of life.

Indications

• Severe infection or gangrene in the toe
• Traumatic injuries (e.g., crush injuries) beyond repair
• Complications from diabetic foot ulcers
• Malignant tumors or other serious conditions affecting the toe

Preparation

• Follow pre-operative fasting instructions, usually no eating or drinking 8 hours before the procedure.
• Discontinue certain medications as advised by the surgeon.
• Undergo necessary diagnostic tests (e.g., blood tests, imaging studies) to assess the extent of the condition and overall health status.

Procedure Description

1. Administration of anesthesia – typically local or regional anesthesia to numb the area, sometimes general anesthesia may be used.
2. The surgeon makes an incision at the joint between the phalanges (toe bones).
3. Dissection and removal of the affected toe joint, ensuring minimal damage to surrounding tissues.
4. Blood vessels are carefully managed to minimize bleeding.
5. The incision is sutured closed and the area is dressed appropriately. Tools used may include scalpels, forceps, and surgical scissors.

Duration

The procedure typically takes around 30 minutes to one hour, depending on the complexity and number of toes being amputated.

Setting

Performed in a hospital operating room or an outpatient surgical center.

Personnel

• Surgeon (usually an orthopedic or general surgeon)
• Anesthesiologist or nurse anesthetist
• Surgical nurses or technologists

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Poor wound healing or dehiscence (wound reopening)
• Phantom limb pain or sensation
• Necrosis of adjacent tissues
• Need for further amputation if healing does not proceed well

Benefits

• Removal of the diseased or damaged toe, thereby preventing the spread of infection.
• Relief from pain and improved ability to use footwear and prosthetics if necessary.
• Improved overall health and avoidance of complications from untreated conditions.

Recovery

• Keep the surgical site clean and dry.
• Follow instructions for wound care and dressing changes.
• Limited mobility and weight-bearing on the affected foot for several weeks.
• Pain management with prescribed medications.
• Regular follow-up appointments for wound assessment and stitches removal if needed.
• Full recovery may take several weeks to months, depending on individual healing rates and overall health.

Alternatives

• Conservative treatment with antibiotics and wound care for less severe conditions.
• Surgical debridement without full amputation for milder cases.
• Pros of alternatives include preservation of the toe if feasible; cons may involve prolonged treatment with uncertain outcomes.

Patient Experience

During the procedure, the patient may be awake if local or regional anesthesia is used but will not feel pain. Post-procedure, there may be some discomfort managed with pain medications. Recovery includes wound care, limited mobility, and follow-up to ensure proper healing. Emotional and psychological support may be beneficial due to the nature of the surgery.