CPT® Code 20827

1. Indications

The replantation of a thumb, as described by CPT® Code 20827, is indicated in cases of complete amputation of the thumb. This procedure is typically performed when the amputation occurs between the distal tip of the thumb and the metacarpophalangeal (MP) joint. The indications for this surgical intervention may include:

• Complete Amputation: The procedure is indicated when the thumb has been completely severed, necessitating surgical reattachment to restore function.
• Traumatic Injury: Commonly resulting from accidents or injuries that lead to the loss of the thumb, making replantation a viable option for recovery.
• Preservation of Function: The goal of the procedure is to restore the thumb's functionality, which is critical for grasping and pinching movements.

2. Procedure

The replantation procedure for a thumb involves several critical steps to ensure successful attachment and healing. The steps include:

• Preparation and Anesthesia: The patient is placed under general anesthesia to ensure comfort and pain management during the procedure. This is a crucial first step that allows the surgical team to operate without causing distress to the patient.
• Tissue Removal: The surgeon begins by carefully removing any damaged or necrotic tissue surrounding the amputation site. This step is vital to prevent infection and to create a clean area for reattachment.
• Bone Trimming: The ends of the amputated bones are then trimmed to create a smooth surface for rejoining. This preparation is essential for aligning the bones properly, which facilitates the subsequent steps of the procedure.
• Rejoining Bones: The trimmed ends of the bones are rejoined, ensuring they are properly aligned to restore the thumb's structural integrity.
• Suturing Soft Tissues: The surgeon meticulously sutures together the arteries, veins, nerves, muscles, and tendons. This step is critical for restoring blood flow and nerve function to the reattached thumb.
• Skin Coverage: In areas where skin is absent, a graft may be applied to cover the exposed tissues. This is important for protecting the underlying structures and promoting healing.
• Free-Tissue Transfer: If necessary, uncovered nerves, tendons, and joints may be covered using a free-tissue transfer, which includes its own blood supply through attached arteries and veins.
• Layered Closure: Finally, the amputation site is closed in layers, ensuring that all tissues are properly aligned and secured to promote optimal healing and minimize scarring.

3. Post-Procedure

After the replantation procedure, the patient will require careful monitoring and follow-up care to ensure proper healing. Post-procedure care may include pain management, wound care, and physical therapy to restore function. The surgical site should be kept clean and dry, and any signs of infection, such as increased redness, swelling, or discharge, should be reported to the healthcare provider immediately. The patient may also need to avoid certain activities that could stress the reattached thumb during the initial recovery period. Regular follow-up appointments will be necessary to assess the healing process and to make any adjustments to the rehabilitation plan as needed.