Ankle disarticulation
CPT4 code
Name of the Procedure:
Ankle Disarticulation
- Common names: Syme's amputation
- Technical term: Ankle disarticulation
Summary
Ankle disarticulation is a surgical procedure where the foot is removed at the level of the ankle joint while preserving the heel pad to enable weight-bearing. It is a form of amputation that aims to maintain as much functionality of the limb as possible.
Purpose
- Addresses severe trauma, infection, or disease (e.g., diabetes, peripheral artery disease).
- Aims to remove the source of pain or infection and facilitate the use of a prosthetic limb.
- Expected outcomes include improved mobility, pain relief, and prevention of further complications.
Indications
- Severe injury or trauma to the foot
- Non-healing diabetic ulcers or infections
- Foot gangrene
- Unmanageable pain
- Congenital deformities
- Peripheral vascular disease leading to necrosis
Preparation
- Pre-procedure instructions include fasting for 8 hours and stopping certain medications (e.g., blood thinners).
- Diagnostic tests: Blood work, X-rays, MRI, or CT scans to assess the extent of damage.
- Physical examination and consultation with the surgical and anesthesiology teams.
Procedure Description
- Anesthesia: General or spinal anesthesia is administered for pain control.
- Incision: A circular incision is made around the ankle joint.
- Disarticulation: The surgeon carefully separates the foot from the tibia and fibula at the joint, preserving the heel pad for future weight-bearing.
- Hemostasis: Blood vessels are sealed to prevent bleeding.
- Closure: The heel pad is attached to the residual limb stump to create a weight-bearing surface.
Tools/Equipment: Scalpels, special amputation saws, cautery devices, sutures, and surgical dressings.
Duration
The procedure typically takes about 2 to 3 hours.
Setting
Performed in a hospital surgical suite under sterile conditions.
Personnel
- Orthopedic or vascular surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Blood clots
- Poor wound healing
- Phantom limb pain
- Residual limb complications (e.g., poor fitting for prosthetics)
Benefits
- Pain relief and removal of infected or necrotic tissue
- Improved ability to use a prosthetic limb for better mobility
- Potentially quicker recovery compared to other types of amputation
Recovery
- Hospital stay of 1-3 days post-surgery
- Wound care and monitoring for infection
- Physical therapy to adapt to using the residual limb and prosthetic fitting in 6-8 weeks
- Expected recovery time is around 4-6 months
- Follow-up appointments with the surgical and rehabilitation team
Alternatives
- Below-knee amputation: Involves removing the leg below the knee for severe cases, allowing for a more functional prosthetic fit.
- Conservative treatments: Including antibiotics, debridement, or reconstructive surgeries.
- Each alternative has pros and cons regarding recovery time, functionality, and suitability for the patient's specific condition.
Patient Experience
- During: The patient will be under anesthesia and will not feel pain or discomfort during the procedure.
- After: Expect some pain and swelling, managed with medications.
- Regular monitoring for signs of infection or complications.
- Encouraged to participate in rehabilitation to regain mobility and adapt to prosthetic use.
- Emotional support and counseling might be necessary to adjust to life post-amputation.