Name of the Procedure:

Upper extremity addition, heavy duty control cable (HCPCS Code L6660)

Summary

The procedure involves the implantation or attachment of a heavy-duty control cable to the upper extremity, often used in conjunction with a prosthetic device to provide improved functionality and control.

Purpose

This procedure aims to enable greater control and functionality for individuals using an upper extremity prosthesis. It addresses issues like limited range of motion or weak prosthetic control. The expected outcomes include enhanced mobility and improved quality of life for the patient.

Indications

The procedure is indicated for patients who:

• Have an upper extremity amputation and use a prosthetic device
• Require enhanced durability and control for their prosthesis
• Experience difficulty with standard control cables Additional criteria may include factors such as the patient’s activity level and specific needs for heavy-duty function.

Preparation

Patients are usually advised to:

• Maintain a normal diet unless otherwise directed
• Continue their current medications but may need to adjust blood thinners
• Undergo a preoperative assessment to ensure they are suitable candidates for the procedure, which may include blood tests, imaging studies, and a review of their medical history.

Procedure Description

1. Preoperative Setup: The patient is positioned comfortably, and the targeted area is cleaned and sterilized.
2. Anesthesia: Local or general anesthesia is administered, depending on the specific requirements and patient comfort.
3. Incision: A small incision is made at the site where the control cable will be attached.
4. Attachment: The heavy-duty control cable is secured to the prosthetic device and the upper extremity, ensuring proper alignment and functionality.
5. Closure: The incision is closed using sutures or surgical adhesive.
6. Postoperative Care: The area is bandaged, and the patient may be monitored briefly for any immediate complications.

Tools and Equipment: Surgical instruments, heavy-duty control cable, prosthetic adjustment tools, sutures.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity and specific needs of the patient.

Setting

The procedure is generally performed in an outpatient surgical center or hospital-based day surgery unit.

Personnel

A team including:

• Orthopedic or prosthetic surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)
• Technical specialists for prosthetic adjustments

Risks and Complications

Common risks include:

• Infection at the incision site
• Bleeding or hematoma formation
• Nerve damage
• Prosthetic device malfunction Rare complications might involve:
• Adverse reactions to anesthesia
• Chronic pain
• Need for revision surgery

Benefits

The expected benefits include:

• Enhanced control and functionality of the prosthetic device
• Improved range of motion and strength
• Increased durability of the prosthesis Benefits are typically realized within a few weeks post-procedure.

Recovery

Post-procedure care includes:

• Keeping the incision site clean and dry
• Avoiding strenuous activities for a specified period
• Attending follow-up appointments for wound check and prosthetic adjustments Full recovery is expected within a few weeks, though this can vary based on individual patient factors.

Alternatives

Other treatment options include:

• Standard control cables (less durable)
• Electronic or myoelectric prostheses (more expensive and may require different skillset) Each alternative has its pros and cons, such as cost, complexity, and functional benefits.

Patient Experience

Patients may experience:

• Minor discomfort or swelling at the incision site
• Initial difficulty in adjusting to the new control cable, which typically improves with practice Pain management may include prescribed medications and recommendations for over-the-counter pain relievers. Comfort measures include proper wound care and gradual resumption of daily activities, aligned with the patient's recovery progress.