CPT® Code 20808

1. Indications

The replantation of a hand, as described by CPT® Code 20808, is indicated in specific circumstances where a complete amputation has occurred. The following conditions warrant this surgical intervention:

• Complete Amputation of the Hand This procedure is performed when the hand has been completely severed from the wrist, necessitating surgical reattachment to restore function.
• Traumatic Injury Situations involving traumatic injuries, such as accidents or severe lacerations, that result in the complete loss of the hand are primary indications for this procedure.
• Severe Crush Injuries In cases where the hand has been crushed to the extent that it is no longer viable, replantation may be considered if the hand can be salvaged.

2. Procedure

The replantation procedure involves several critical steps to ensure the successful reattachment of the hand. Each step is essential for restoring both the structural integrity and functionality of the hand.

• Step 1: Anesthesia Administration The procedure begins with the administration of general anesthesia to the patient, ensuring they are unconscious and free from pain during the surgery.
• Step 2: Tissue Preparation Once the patient is anesthetized, the surgeon carefully assesses the amputation site and removes any damaged or necrotic tissue surrounding the area. This step is crucial for preventing infection and promoting healing.
• Step 3: Bone Trimming The ends of the amputated bones are then trimmed to create a clean surface for reattachment. This preparation facilitates better alignment and stabilization of the bones during the replantation process.
• Step 4: Bone Reattachment After trimming, the bones are rejoined using appropriate fixation techniques to ensure they are securely held in place, which is vital for the overall success of the procedure.
• Step 5: Soft Tissue Reconstruction The surgeon proceeds to suture together the soft tissues, including arteries, veins, nerves, muscles, and tendons. This step is critical for restoring blood flow and nerve function to the hand.
• Step 6: Skin Grafting In instances where there is insufficient skin coverage, a graft is applied to protect the underlying structures and promote healing.
• Step 7: Free-Tissue Transfer If necessary, uncovered nerves, tendons, and joints may be covered using a free-tissue transfer, which includes the transfer of tissue along with its blood supply to ensure adequate perfusion.
• Step 8: Layered Closure Finally, the amputation site is closed in layers, which helps to ensure proper healing and reduces the risk of complications such as infection or dehiscence.

3. Post-Procedure

After the replantation procedure, the patient will require careful monitoring and post-operative care to ensure proper healing and recovery. This may include pain management, wound care, and physical therapy to regain function in the hand. The surgical site will need to be kept clean and dry, and any signs of infection or complications should be promptly addressed. Follow-up appointments will be necessary to assess the healing process and the functionality of the reattached hand. Rehabilitation may involve exercises to improve strength and mobility, and the timeline for recovery can vary based on the extent of the injury and the success of the replantation.