CPT® Code 24920

1. Indications

The procedure of arm amputation through the humerus, specifically CPT® Code 24920, is indicated for various medical conditions that may necessitate the removal of the arm above the elbow. These indications include:

• Severe Trauma: Cases where the arm has sustained irreparable damage due to accidents or injuries.
• Malignancy: Situations where cancerous growths in the arm require amputation to prevent the spread of cancer or to alleviate symptoms.
• Infection: Instances of severe infection that do not respond to conservative treatment and pose a risk to the patient's health.
• Vascular Compromise: Conditions where blood flow to the arm is severely compromised, leading to tissue necrosis.

2. Procedure

The procedure for a circular amputation of the arm through the humerus involves several critical steps, which are detailed as follows:

• Step 1: The patient is positioned with the shoulder slightly elevated on the operative side to provide optimal access to the surgical site. The surgical team marks the skin incision lines in a circular fashion at the predetermined site on the upper arm.
• Step 2: An incision is made along the marked circular lines, allowing access to the underlying soft tissue. The incision is made carefully to minimize trauma to surrounding structures.
• Step 3: The soft tissue is dissected, and blood vessels and nerves are identified. These structures are then ligated and transected to prevent excessive bleeding during the procedure.
• Step 4: The underlying muscle tissue is transected at a point proximal to the skin incision, ensuring that the muscle is cut cleanly to facilitate closure.
• Step 5: Periosteal flaps are created around the humerus, which is then transected slightly higher than the muscle to ensure a clean cut and proper closure.
• Step 6: The periosteal flaps, along with the muscle and skin, are closed over the remaining bone. This step is crucial for protecting the bone and promoting healing.
• Step 7: A rigid dressing is applied to the surgical site to reduce pain and prevent edema, ensuring that the area remains stable during the initial recovery phase.

3. Post-Procedure

After the completion of the circular amputation procedure, the patient will require careful monitoring and post-operative care. This includes managing pain through appropriate analgesics, monitoring for signs of infection, and ensuring that the dressing remains intact. The patient may also need physical therapy to aid in rehabilitation and to adapt to the changes following the amputation. Follow-up appointments will be necessary to assess healing and to discuss options for prosthetic fitting if applicable. The surgical team will provide specific instructions regarding activity restrictions and care of the surgical site to promote optimal recovery.