CPT® Code 24931

1. Indications

The procedure described by CPT® Code 24931 is indicated for patients who require an amputation of the arm through the humerus due to various medical conditions or circumstances. The following are the explicitly provided indications for this procedure:

• Severe Trauma: Significant injuries to the arm that cannot be repaired or salvaged may necessitate amputation.
• Malignancy: The presence of tumors or cancerous growths in the arm that compromise the integrity of the humerus may require amputation.
• Infection: Uncontrolled infections that threaten the patient's health and cannot be managed through other means may lead to the need for amputation.
• Vascular Insufficiency: Conditions that result in poor blood flow to the arm, leading to tissue death or necrosis, may necessitate amputation.

2. Procedure

The procedure for an arm amputation through the humerus with an implant involves several critical steps, each designed to ensure the successful removal of the limb while preparing for the implantation of a prosthetic device. The following procedural steps are outlined:

• Step 1: The patient is positioned with the shoulder slightly elevated on the operative side to facilitate access to the arm. The surgical team marks the incision lines for the skin and muscle flaps, ensuring that they are long enough to adequately cover the prosthetic implant.
• Step 2: An incision is made through the skin and superficial fascia, which is done perpendicular to the skin surface. This initial incision allows access to the underlying soft tissues.
• Step 3: The surgeon dissects the underlying soft tissue to expose the blood vessels and nerves. Care is taken to identify and preserve these structures as much as possible.
• Step 4: Large blood vessels are mobilized, and once adequately exposed, they are suture ligated and divided to prevent excessive bleeding during the procedure.
• Step 5: Nerves are also mobilized from the muscular bed, doubly ligated, and divided, allowing them to retract into the muscle tissue to minimize potential complications.
• Step 6: The muscles are transected along the previously marked flap lines, which prepares the area for the amputation of the humerus.
• Step 7: The humerus is then exposed and transected at the designated site, after which the stump is prepared and sized for the prosthetic implant.
• Step 8: An appropriate prosthetic implant is selected based on the size and shape of the humeral stump, and it is secured to the stump to ensure stability.
• Step 9: The muscle flaps are sutured over the remaining bone and the implant, ensuring that the prosthetic device is well-covered.
• Step 10: Antagonistic muscle groups are sutured to each other and anchored in a manner that completely envelops the remaining portion of the humerus and the implant, providing additional support.
• Step 11: To prevent movement of the muscle tissue, muscle sutures may be reinforced using synthetic tape that is placed through drill holes in the humerus.
• Step 12: Drains are placed to manage any potential fluid accumulation, and the subcutaneous fascia and skin are closed around the drains to complete the procedure.
• Step 13: Finally, a rigid dressing is applied to the surgical site to reduce pain and prevent edema, ensuring a stable environment for healing.

3. Post-Procedure

After the completion of the amputation procedure, patients typically require careful monitoring and post-operative care to ensure proper healing and recovery. Expected post-procedure care includes managing pain through appropriate analgesics, monitoring for signs of infection at the surgical site, and ensuring that the drains are functioning correctly. Patients may also need physical therapy to aid in rehabilitation and to adapt to the use of the prosthetic implant. Follow-up appointments are essential to assess the healing process, adjust the prosthetic device as necessary, and provide ongoing support for the patient's recovery journey.