CPT® Code 24935

1. Indications

The procedure of stump elongation for the upper extremity is indicated for patients who have undergone amputation and require modifications to their residual limb to enhance the fit and functionality of a prosthesis. The following conditions may warrant this surgical intervention:

• Improper Fit of Prosthesis The patient experiences discomfort or instability with their current prosthetic device due to inadequate length or shape of the residual limb.
• Limited Mobility The patient has restricted movement or functionality of the remaining limb, impacting their ability to perform daily activities.
• Bone Shortening The residual limb has not healed properly, resulting in a shorter bone length that necessitates elongation for better prosthetic integration.
• Desire for Improved Aesthetics The patient seeks to enhance the appearance of their limb to achieve a more natural look with the prosthesis.

2. Procedure

The stump elongation procedure involves several critical steps to ensure successful elongation of the upper extremity. Each step is designed to carefully manipulate the bone and surrounding tissues while minimizing risks.

• Step 1: Marking Incision Lines The surgical process begins with the precise marking of incision lines on the skin, which guides the surgeon in making incisions that will provide access to the underlying structures.
• Step 2: Incision and Dissection The skin and underlying soft tissue are incised to expose the muscles. Surgeons must perform this step with caution to protect the nerves and blood vessels that are critical for limb function.
• Step 3: Exposure of the Humerus Once the muscles are dissected, the humerus is exposed, and the periosteum is incised to allow access to the bone for elongation.
• Step 4: Bone Elongation The elongation of the bone can be achieved using either vascularized bone flaps or a bone stretching device. If vascularized bone flaps are chosen, they are harvested and shaped in a separate procedure before being placed between the two segments of the transected bone.
• Step 5: Internal Fixation The vascularized bone flaps are secured with internal fixation devices, and the flaps are sutured over the remaining bone to ensure stability and promote healing.
• Step 6: Muscle Group Suturing Antagonistic muscle groups are sutured together and anchored to the periosteum, enveloping the remaining portion of the humerus in muscle to support the new bone structure.
• Step 7: Skin Closure Finally, skin flaps are fashioned and sutured over the muscle to complete the procedure and protect the surgical site.
• Step 8: External Fixation (if applicable) Alternatively, if an external fixation device is used, the bone is transected, and the device is applied. The external fixation frame is adjusted multiple times daily to gradually separate the bone segments, allowing new bone to form in the gap.

3. Post-Procedure

After the stump elongation procedure, patients will require careful monitoring and follow-up care to ensure proper healing and integration of the new bone. Post-operative care may include pain management, physical therapy to enhance mobility, and regular assessments to monitor the healing process. If an external fixation device was used, patients will need to adhere to a schedule for adjustments to the device, which facilitates the gradual lengthening of the bone. The expected recovery time may vary based on the individual’s health status and the complexity of the procedure, but patients should be prepared for a rehabilitation period that focuses on restoring function and adapting to the prosthesis.