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An amputation through the wrist joint, referred to as disarticulation, involves the surgical removal of the hand and wrist at the level of the wrist joint. This procedure is indicated when there is a need to remove diseased, infected, or nonviable tissue that poses a risk to the patient’s health. The surgery aims to create a healthy stump that can accommodate a prosthesis, thereby enhancing the patient's functional capabilities. During the procedure, various anatomical structures are carefully managed, including the division of finger flexor and extensor tendons, as well as the identification and sectioning of the median and ulnar nerves. The radial and ulnar arteries are also ligated to control bleeding. The surgical technique ensures that the triangular fibrocartilage is preserved, which is crucial for the integrity of the wrist joint. The final steps involve the careful configuration of skin and soft tissue flaps to cover the newly formed stump, ensuring that it is suitable for prosthetic fitting and functional use.
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The procedure of disarticulation through the wrist, specifically re-amputation, is indicated for the following conditions:
The procedure for re-amputation at the wrist involves several critical steps to ensure a successful outcome. First, the incision lines for the re-amputation are carefully marked on the skin to guide the surgical approach. Following this, the skin and underlying soft tissue are incised to expose the deeper anatomical structures. The muscles are then exposed and isolated by muscle group, allowing for precise division. During this process, nerves and blood vessels are identified and isolated to prevent any inadvertent damage. It is essential to separate the nerves from the arteries to avoid pulsatile irritation, which can lead to complications. Once identified, the nerves are transected and allowed to retract into the surrounding soft tissue. Blood vessels are then suture ligated and transected to control bleeding effectively. If necessary, bone is removed to achieve the desired stump configuration. Finally, skin flaps are fashioned and sutured over the muscle to create a well-formed stump that is ready for healing and subsequent prosthetic fitting.
After the re-amputation procedure, careful post-operative care is essential to promote healing and prevent complications. The patient will require monitoring for signs of infection and proper wound care to ensure that the surgical site remains clean and free from contaminants. Pain management will be an important aspect of post-operative care, as the patient may experience discomfort following the surgery. Rehabilitation may be initiated to help the patient adapt to the new stump and prepare for prosthetic fitting. This may include physical therapy to strengthen the surrounding muscles and improve mobility. The healthcare team will provide guidance on caring for the stump and preparing for the eventual use of a prosthesis, ensuring that the patient can regain functionality and quality of life.
| Short Descr | AMPUTATION FOLLOW-UP SURGERY | Medium Descr | DISARTICULATION THRU WRIST RE-AMPUTATION | Long Descr | Disarticulation through wrist; re-amputation | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 164 - Other OR therapeutic procedures on musculoskeletal system |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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