Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nerves
CPT4 code
Name of the Procedure:
Amputation, ankle, through malleoli of tibia and fibula (Syme or Pirogoff type procedures) with plastic closure and resection of nerves.
Summary
This surgical procedure involves removing the foot at the ankle level, specifically through the bony prominences of the tibia and fibula (malleoli). The surgery includes techniques to close the wound with healthy tissue and resection of nerve endings to reduce pain.
Purpose
The procedure is intended to address severe foot injuries, infections, or conditions like diabetic ulcers that cannot be managed with less drastic measures. The goals are to remove the affected area, prevent further complications, and preserve as much function as possible.
Indications
- Severe trauma to the foot or ankle
- Infections not responding to antibiotics
- Advanced diabetic foot ulcers
- Uncontrollable pain due to nerve damage
- Cancer or tumors in the foot or ankle area
Preparation
- Patients are generally required to fast for 8-12 hours before the surgery.
- Adjustments in medication, particularly blood thinners, as directed by the surgeon.
- Diagnostic tests including blood tests, X-rays, or MRI to assess the condition of the foot and surrounding areas.
Procedure Description
- Anesthesia: General anesthesia is typically administered.
- Incision: A precise incision is made around the ankle through the tibia and fibula's malleoli.
- Bone Removal: The lower portion of these bones is carefully removed.
- Nerve Resection: Nerve endings are trimmed to minimize post-operative pain.
- Plastic Closure: The remaining tissue is used to cover the bone end, ensuring adequate skin and muscle coverage to aid healing.
- Stitching: The incision is closed with sutures or staples.
Tools used include surgical scalpels, saws for bone cutting, and specialized equipment for nerve handling.
Duration
The procedure typically takes 1.5 to 3 hours.
Setting
Usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic or vascular surgeon
- Anesthesiologist
- Surgical nurse
- Operating room technician
Risks and Complications
- Infection
- Blood clots
- Phantom limb pain
- Delayed wound healing
- Adverse reactions to anesthesia
Benefits
- Alleviation of chronic pain or infection
- Prevention of the spread of infection
- Improved quality of life
- Potential for using a prosthesis
Recovery
- Hospital stay of 1-2 days post-surgery
- Pain management with prescribed medications
- Follow-up visits for wound care and to monitor healing
- Physical therapy may be required to adapt to the change
- Full recovery typically takes several weeks to a few months
Alternatives
- Limb salvage procedures
- Advanced wound care techniques
- Hyperbaric oxygen therapy
- Each alternative has varying success rates and may not be suitable for every patient
Patient Experience
Patients may experience significant pain immediately after the procedure, managed by strong painkillers. During recovery, there may be discomfort and an adaptation period for using a prosthetic device. Emotional and psychological support is also essential during recovery.