26910 Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer

Name of the Procedure:

Amputation, Metacarpal, with Finger or Thumb (Ray Amputation), Single, with or without Interosseous Transfer

Summary

In layman's terms, a metacarpal amputation involves surgically removing a finger or thumb from the hand along with its corresponding metacarpal bone. This procedure can include the transfer of interosseous muscles, which are small muscles located between the bones of the hand, to optimize hand function post-amputation.

Purpose

The procedure addresses severe injuries, infections, or diseases affecting a finger or thumb, such as severe trauma, malignancy, gangrene, or irreparable damage due to conditions like frostbite. The goal is to relieve pain, remove diseased tissue, and preserve as much hand functionality as possible.

Indications

• Severe trauma to a finger or thumb.
• Malignant tumors in the finger or thumb.
• Gangrene or severe infections.
• Irreparable damage from conditions like frostbite.
• Severe arthritis or congenital deformities impairing function.

Preparation

• Fasting for at least 8 hours before the surgery.
• Adjustments to medications, particularly blood thinners.
• Pre-operative diagnostic tests like X-rays or MRIs for surgical planning.
• Physical examination and blood tests to assess overall health.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia or regional block.
2. Incision: The surgeon makes an incision around the affected finger or thumb, extending down to the metacarpal bone.
3. Removal: The soft tissues and bones of the digit and associated metacarpal bone are carefully removed.
4. Interosseous Transfer: If indicated, interosseous muscles are transferred to preserve and optimize remaining hand function.
5. Closure: The incision is closed with stitches, and a dressing is applied to the wound.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room or a dedicated surgical center.

Personnel

• Orthopedic or hand surgeon.
• Anesthesiologist.
• Surgical nurses and technicians.

Risks and Complications

• Infection and bleeding.
• Poor wound healing or issues with the remaining hand function.
• Nerve damage or formation of a neuroma.
• Phantom limb pain.

Benefits

• Relief from pain or infection.
• Removal of malignant or diseased tissue.
• Improved overall hand function and appearance.
• Ability to use prosthetics for enhanced function.

Recovery

• Post-procedure care includes wound care, pain management, and antibiotics to prevent infection.
• Physical therapy to improve hand function and strength.
• Expected recovery time is several weeks to a few months, depending on individual healing rates.
• Follow-up appointments for monitoring and suture removal.

Alternatives

• Limb-sparing surgeries if only a part of the finger or thumb is affected.
• Joint fusion or reconstruction.
• Physical therapy and medication for milder conditions.
• Pros of alternatives: Preserves more of the natural hand structure.
• Cons: May not be applicable if the damage is extensive or severe.

Patient Experience

• The patient will be under anesthesia during the procedure and will not feel pain.
• Post-operative pain is managed with medication.
• Initial discomfort, swelling, and limited hand function, improving gradually with therapy and healing.
• Emotional and psychological support may be needed to adjust to the changes in hand functionality.

Pain management, physical therapy, and emotional support are key components of post-operative care to ensure the best possible outcome for the patient.