27591 Amputation, thigh, through femur, any level; immediate fitting technique including first cast

Name of the Procedure:

Amputation, thigh, through femur, any level; immediate fitting technique including first cast
Common name(s): Thigh Amputation, Femoral Amputation with Immediate Prosthetic Fitting
Medical term: Transfemoral Amputation

Summary

A thigh amputation through the femur involves surgically removing the lower limb above the knee. The immediate fitting technique includes placing the first prosthetic cast directly after surgery.

Purpose

This procedure is performed to address severe trauma, infections, cancer, or other conditions where limb preservation is not possible. The goals include removing non-viable tissue, preventing further medical complications, and promoting early mobility with a prosthetic limb.

Indications

• Severe infections (e.g., osteomyelitis)
• Traumatic injury beyond repair
• Malignancies in the lower limb
• Severe peripheral arterial disease
• Irreparable nerve damage or deformity

Preparation

• Detailed medical history and physical examination
• Imaging studies (e.g., X-ray, MRI) to assess the extent of injury or disease
• Blood tests and potential cardiac evaluation
• Fasting 8-12 hours before surgery
• Discontinuation of certain medications as advised by the healthcare provider

Procedure Description

1. Anesthesia is administered (general or regional).
2. The surgeon makes an incision in the thigh, carefully dissecting tissues to spare as much viable muscle, nerve, and skin as possible.
3. The femur is cut at the appropriate level.
4. Major blood vessels and nerves are carefully managed and sealed.
5. The wound is closed, and a custom-made cast that includes a prosthetic fitting is applied.
6. The prosthetic cast helps to start early rehabilitation and mobility.

Duration

The procedure typically lasts 2 to 4 hours, depending on the complexity and level of amputation.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Prosthetist (for the fitting cast)
• Rehabilitation team

Risks and Complications

• Infection
• Blood clots (deep vein thrombosis)
• Phantom limb pain or sensation
• Poor wound healing
• Prosthetic fitting issues
• Residual limb complications (e.g., skin problems)

Benefits

• Alleviation of debilitating symptoms
• Prevention of life-threatening infections
• Enhanced quality of life through early mobility with a prosthetic limb
• Psychological and physical adaptation to the limb loss

Recovery

• Hospital stay of approximately 3-7 days
• Pain management with medications
• Physical therapy begins almost immediately
• Gradual weight-bearing on the prosthetic cast
• Regular follow-up for cast adjustments and rehabilitation therapy
• Full recovery can vary from weeks to months depending on individual health and rehabilitation progress

Alternatives

• Limb-preserving surgery (if feasible)
• Custom orthopedic devices or bracing for limb support
• Non-surgical management (e.g., antibiotics for infection, chemotherapy for malignancies)

Patient Experience

During the procedure, patients will not feel any discomfort due to anesthesia. Post-surgery, patients may experience pain and swelling, managed with medications. Rehabilitation involves physical therapy to adapt to the prosthetic limb, focusing on mobility and strengthening exercises. Emotional and psychological support is often necessary to adjust to life post-amputation.