26952 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood)

Name of the Procedure:

Amputation of Finger or Thumb
Technical Term: Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood)

Summary

This procedure involves the surgical removal of a finger or thumb at any joint or phalanx. The surgery includes the use of local tissue (advanced flaps) to reconstruct the area. Neurectomies, or the removal of small nerve sections, are also performed to alleviate pain.

Purpose

Medical Condition or Problem Addressed: Severe injury, infection, or disease (e.g., frostbite, cancer, or severe arthritis) leading to non-viable and non-functional tissue.
Goals and Expected Outcomes: To remove damaged tissue, prevent the spread of infection or disease, and create a functional and cosmetically acceptable stump for possible prosthetic fitting.

Indications

Specific Symptoms or Conditions: Non-viable and infected tissue, irreparable traumatic injury, malignant tumors, severe pain from conditions like arthritis not relieved by other treatments.
Patient Criteria: Patients with significant damage or disease affecting the finger or thumb, non-responders to conservative treatments, and those without significant co-morbidities that would preclude surgery.

Preparation

• Pre-procedure Instructions: Patients may be required to fast for 6-8 hours before surgery. Specific medication adjustments, especially for blood thinners or diabetic treatments, will be advised.
• Diagnostic Tests/Assessments: Blood tests, imaging studies (X-ray, MRI), and possibly nerve conduction studies to determine the extent of damage.

Procedure Description

1. Anesthesia: Administered local or general anesthesia depending on the complexity and patient condition.
2. Incision: An incision is made at the targeted joint or phalanx.
3. Amputation: The surgeon carefully removes the affected part of the finger or thumb.
4. Neurectomies: Nerve endings are treated to reduce pain.
5. Advancement Flaps: Local tissue flaps (V-Y or hood technique) are created to cover the stump, ensuring good healing and cosmetic outcome.
6. Closure: Sutures or staples are used to close the surgical site.
7. Dressing: A sterile dressing is applied to protect the wound.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon
• Surgical Nurse
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common Risks: Infection, bleeding, pain, and swelling.
• Rare Risks: Nerve damage, delayed healing, and reactions to anesthesia.
• Management: Antibiotics for infections, pain medications, and follow-up care to monitor healing and manage any complications.

Benefits

• Expected Benefits: Removal of diseased or non-functional tissue, relief from pain, prevention of infection spread, enhanced function through improved prosthetic fitting.
• Time to Realize Benefits: Immediate relief from the source of infection or trauma; full benefits realized as the surgery heals, typically within a few weeks.

Recovery

• Post-procedure Care: Wound care instructions, pain management with prescribed medication, and physical therapy exercises if needed.
• Recovery Time: Complete recovery usually takes 4 to 6 weeks.
• Restrictions: Avoid heavy lifting or strenuous activity with the affected hand. Follow-up appointments for wound assessment and suture/staple removal.

Alternatives

• Other Treatment Options: Conservative treatments like antibiotics for infection or pain management strategies. Reconstructive surgeries or prosthetics without amputation.
• Pros and Cons: Conservative treatments may not be effective in severe cases, while reconstructive surgeries might not provide complete restoration of function.

Patient Experience

• During Procedure: The patient will be under anesthesia, either local or general, and will not feel pain.
• After Procedure: There may be some post-operative pain managed by medications, discomfort from the surgical dressing, and some limitations in hand use during early recovery. Pain management, including medications and possibly nerve blocks, will be provided for comfort.