Name of the Procedure:

Terminal Device, Hook or Hand, Heavy Duty, Mechanical, Voluntary Opening
Technical Term: HCPCS Code L6721

Summary

This procedure involves the fitting and customization of a mechanical prosthetic hand or hook, designed for heavy-duty use. The device operates via a voluntary opening mechanism, meaning it opens when the user applies force and closes automatically. These devices can be made from various materials and may come lined or unlined based on user preference.

Purpose

Terminal devices like mechanical hands or hooks are designed to help individuals with upper limb amputations or congenital limb deficiencies regain functionality and independence. The main goals include improving the ability to perform daily tasks, enhancing mobility, and increasing the quality of life for the patient.

Indications

• Upper limb amputation or congenital limb deficiency.
• Patients requiring durable and robust prosthetic devices to perform demanding physical activities.
• Individuals who prefer a mechanical over an electronic prosthetic device, offering more tactile feedback and robustness.

Preparation

• Pre-procedure consultation to assess the patient's specific needs and preferences.
• Measurements and impressions of the residual limb to ensure a proper fit.
• Discussion of material choices (e.g., steel, titanium, plastic) and lining options.
• No specific fasting or medication adjustments are typically required.

Procedure Description

1. Initial Consultation: A healthcare provider assesses the patient's needs and evaluates the residual limb.
2. Measurement and Molding: Detailed measurements and/or a mold of the residual limb are taken to customize the device.
3. Fitting and Adjustment: The mechanical voluntary opening device is fitted to the patient. Fine-tuning and adjustments are made for optimal function and comfort.
4. Training: The patient receives training on how to use and maintain the device effectively.

Tools and Equipment:

• Measurement tools (tape measure, calipers).
• Molding materials.
• Mechanical hand or hook device.
• Adjustment tools.

Anesthesia or Sedation: Not applicable for the fitting process.

Duration

The fitting process typically takes several hours over multiple visits.

Setting

The procedure is usually performed in a prosthetic fitting clinic or an outpatient rehabilitation facility.

Personnel

• Prosthetist (specialist in fitting and manufacturing prosthetic limbs).
• Occupational Therapist (to assist with training and functionality).
• Prosthetic Technician (assists with adjustments and device customization).

Risks and Complications

• Common Risks: Skin irritation or pressure sores at the site of the device contact.
• Rare Risks: Mechanical failure of the device, allergic reactions to materials used.
• Management: Follow-up appointments for adjustments, routine maintenance of the device.

Benefits

• Functionality: Restores the ability to perform daily tasks and engage in heavy-duty activities.
• Independence: Enhances the patient’s ability to live independently.
• Quality of Life: Improves overall well-being and self-esteem.

Recovery

• Post-Procedure Care: Regular cleaning and maintenance of the device. Monitoring for any skin irritation.
• Recovery Time: Immediate usage post-fitting with a brief adaptation period.
• Restrictions: No specific restrictions, but patient should adhere to usage guidelines.
• Follow-Up: Regular follow-up appointments for adjustments and checks on device integrity.

Alternatives

• Electronic Prostheses: Offer fine motor control but may be less durable.
• Body-Powered Prostheses: Different mechanisms like voluntary closing devices.
• No Prosthesis: Some patients may choose not to use a prosthetic device and rely on other adaptive methods.

Pros and Cons of Alternatives:

• Electronic prostheses may provide more dexterity but are often more expensive and require power sources.
• Body-powered devices may offer simpler mechanics but may not be as robust for heavy-duty activities.

Patient Experience

• During the Procedure: Patients may feel mild discomfort during the mold-taking and fitting process.
• After the Procedure: Some initial soreness may occur as the patient adapts to using the device. Pain management is typically not necessary.
• Comfort Measures: Proper fitting and regular adjustments ensure comfort. Training on usage optimizes the device’s benefits.