CPT® Code 24940

1. Indications

The cineplasty procedure is indicated for patients who have undergone an amputation of the upper extremity and require a functional prosthetic limb that can be controlled by muscle contraction. The specific indications for this procedure include:

• Upper Extremity Amputation Patients with a complete amputation of the arm or forearm who seek improved control and functionality of a prosthetic device.
• Muscle Group Isolation Situations where there is a need to isolate specific muscle groups in the chest or arm to enhance the control of a prosthetic limb.
• Prosthetic Rehabilitation Individuals who are candidates for advanced prosthetic rehabilitation that requires the integration of muscle control for optimal performance.

2. Procedure

The cineplasty procedure involves several critical steps that are performed with precision to ensure successful outcomes. The procedural steps include:

• Step 1: Incision and Muscle Exposure The procedure begins with a surgical incision made in the skin over the area where the muscle groups are located. This incision allows the surgeon to access the pectoral, biceps, triceps, or forearm muscles, which are essential for the subsequent steps of the procedure.
• Step 2: Muscle Loop Development or Tunnel Creation Depending on the level of amputation, the surgeon will either develop a loop of muscle in cases of upper arm (humeral) amputation or create a muscle tunnel in the case of lower arm amputations. This step is crucial for establishing a functional connection between the muscle and the prosthetic device.
• Step 3: Myoplasty The surgeon may perform a myoplasty, which involves isolating pairs of agonist and antagonist muscles. These muscle pairs are tied off to ensure they can work together effectively to control the prosthesis, enhancing the patient's ability to operate the device.
• Step 4: Myodesis In some cases, myodesis may be performed, which involves attaching the muscle directly to the bone. This technique can be used in conjunction with myoplasty to provide additional stability and control over the prosthetic limb.
• Step 5: Skin Graft Harvesting and Preparation Full-thickness skin grafts are harvested from donor sites, typically the abdomen or upper thigh. These grafts are prepared to the necessary dimensions for suturing over the exposed muscle area.
• Step 6: Grafting and Muscle Attachment The prepared skin grafts are sutured over the muscle loop or tunnel, providing coverage and protection. Finally, the muscle is attached to the prosthesis in a manner that allows it to be used for operating the device through muscular contraction.

3. Post-Procedure

After the cineplasty procedure, patients will require careful monitoring and post-operative care to ensure proper healing and integration of the muscle with the prosthetic device. Expected recovery may involve physical therapy to help the patient adapt to the new prosthesis and learn how to control it effectively using the isolated muscle. Follow-up appointments will be necessary to assess the healing process, the functionality of the prosthesis, and to make any necessary adjustments. Patients may also need to manage pain and monitor for any signs of infection at the surgical site. Overall, the success of the procedure relies on a comprehensive rehabilitation plan that supports the patient's transition to using the prosthetic limb.