CPT® Code 20838

1. Indications

The replantation of a foot that has been completely amputated at or near the ankle is indicated in specific circumstances where the preservation of the foot is deemed necessary for functional and aesthetic reasons. The following conditions may warrant this procedure:

• Traumatic Amputation: The procedure is indicated for patients who have experienced a traumatic amputation of the foot due to accidents, such as industrial injuries, severe lacerations, or crush injuries.
• Severe Vascular Compromise: In cases where the foot has been amputated but the vascular supply can be restored, replantation is considered to salvage the limb and restore blood flow.
• Patient's Desire for Limb Preservation: Patients who express a strong desire to preserve their foot for functional use or cosmetic reasons may be candidates for this procedure, provided that the amputation is suitable for reattachment.

2. Procedure

The replantation procedure involves several critical steps to ensure the successful reattachment of the amputated foot. Each step is performed with precision and care to maximize the chances of a favorable outcome.

• Step 1: Anesthesia Administration The procedure begins with the administration of general anesthesia to the patient, ensuring they are completely 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 vital to prevent infection and promote healing.
• Step 3: Bone Trimming The ends of the amputated bones are then trimmed to create a clean surface for rejoining. This preparation is essential for aligning the soft tissues effectively during the reattachment process.
• Step 4: Rejoining Structures The surgeon meticulously sutures together the arteries, veins, nerves, muscles, and tendons. This step is crucial for restoring blood flow, sensation, and movement to the reattached foot.
• Step 5: Grafting In areas where skin coverage is lacking, a graft is applied to protect the underlying structures and facilitate healing. This may involve using skin from another part of the patient's body or a donor site.
• Step 6: Free-Tissue Transfer If there are exposed nerves, tendons, or joints, a free-tissue transfer may be performed. This involves taking a section of tissue along with its blood supply to cover these vulnerable areas.
• Step 7: Layered Closure Finally, the amputation site is closed in layers. This technique helps to ensure that the underlying structures are well protected and that the skin heals properly, minimizing the risk of complications.

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 reattached foot. The surgical site will need to be kept clean and dry, and the patient may be advised to limit weight-bearing activities for a specified period to allow for optimal healing. Follow-up appointments will be necessary to assess the success of the replantation and to monitor for any potential complications, such as infection or issues with blood flow to the reattached foot.