CPT® Code 25915

1. Indications

The Krukenberg procedure is indicated for specific conditions related to the forearm and hand. The following are the primary indications for performing this procedure:

• Congenital Absence of the Hand This condition refers to individuals who are born without a hand, necessitating reconstructive surgery to enhance functionality.
• Traumatic Amputation at the Wrist This indication involves patients who have lost their hand due to an accident or injury, requiring surgical intervention to restore some level of hand function.
• Therapeutic Amputation at the Wrist This situation arises when a hand is surgically removed due to medical reasons, such as severe infection or malignancy, and reconstruction is needed to improve the patient's ability to grasp and manipulate objects.

2. Procedure

The Krukenberg procedure consists of several detailed steps that are crucial for achieving the desired functional outcome. Each step is performed with precision to ensure the best possible results for the patient.

• Step 1: Incision The procedure begins with an incision made along the midline of the anterior aspect of the forearm. This incision extends over the stump and continues into the posterior forearm, providing access to the underlying structures.
• Step 2: Dissection of Soft Tissues Following the incision, the surgeon carefully dissects the soft tissues to expose the muscles and bones. The overlying muscles are divided longitudinally into equal halves to facilitate further manipulation.
• Step 3: Separation of Muscles The flexor digitorum sublimis and flexor digitorum profundus muscles are separated using blunt dissection techniques. This step is essential for accessing the interosseous membrane and the bones of the forearm.
• Step 4: Division of the Interosseous Membrane The interosseous membrane, which connects the radius and ulna, is carefully divided. During this step, special attention is given to protecting the interosseous blood vessels to maintain blood supply to the forearm.
• Step 5: Evaluation and Excision of Bone The lengths of the radius and ulna are evaluated, and any excess bone is excised as necessary to ensure proper alignment and functionality of the forearm.
• Step 6: Rearrangement of Forearm Muscles The forearm muscles are then rearranged and sutured over the tips of each bone. This step is critical for providing the necessary support and mobility to the newly formed structure.
• Step 7: Coverage of Bones The radius and ulna are separately covered with skin from the forearm, along with skin grafts if needed. This ensures that the bones are adequately protected and that the skin can heal properly.
• Step 8: Placement of Drains Finally, drains are placed as needed in each of the stumps to prevent fluid accumulation and promote healing.

3. Post-Procedure

After the completion of the Krukenberg procedure, patients typically require careful monitoring and post-operative care to ensure proper healing. The expected recovery period may vary depending on individual circumstances, but it generally involves managing pain, monitoring for signs of infection, and ensuring that the surgical site is healing appropriately. Rehabilitation may be necessary to help the patient regain strength and functionality in the forearm, focusing on exercises that promote mobility and dexterity. Follow-up appointments will be essential to assess the healing process and make any necessary adjustments to the treatment plan.