CPT® Code 28344

1. Indications

The procedure coded as CPT® 28344 is indicated for the surgical reconstruction of toes affected by polydactyly. The specific indications for this procedure include:

• Polydactyly Type I - Involves soft tissue duplication without bony involvement, necessitating reconstruction to create a single digit.
• Polydactyly Type II - Involves duplication of the digit that includes bone and/or cartilage, requiring surgical intervention to excise the duplicated structures.
• Polydactyly Type III - Complete duplication of the digit and metacarpal, which requires a more extensive reconstruction to restore normal anatomy and function.
• Pre-axial Polydactyly - Presence of an extra great toe that must be reconstructed to form a single functional digit.
• Post-axial Polydactyly - Involves an extra little toe that requires surgical reconstruction to achieve a single digit.
• Central Polydactyly - Involves an extra toe in the central part of the foot, typically requiring a more complex reconstruction of both the forefoot and the toes.

2. Procedure

The surgical procedure for CPT® Code 28344 involves several critical steps to effectively reconstruct the duplicated digit. The following procedural steps are typically undertaken:

• Step 1: Preoperative Assessment - A thorough evaluation of the patient's foot structure is conducted, including imaging studies to determine the extent of polydactyly and the specific anatomical features that need to be addressed during surgery.
• Step 2: Anesthesia Administration - The patient is administered appropriate anesthesia to ensure comfort and pain management throughout the surgical procedure.
• Step 3: Incision and Exposure - An incision is made to access the affected area of the foot. Care is taken to minimize damage to surrounding tissues while providing adequate exposure to the duplicated digit.
• Step 4: Excision of Duplicated Structures - The duplicated digit, including any excess bone or cartilage, is carefully excised. This step is crucial to prevent complications and to prepare the site for reconstruction.
• Step 5: Reconstruction of the Single Digit - The remaining structures, including skin, soft tissue, tendons, joints, and ligaments, are meticulously rearranged and reconstructed to form a single, functional digit. This may involve suturing techniques to ensure proper alignment and healing.
• Step 6: Closure of Incision - Once the reconstruction is complete, the incision is closed using sutures or other closure methods, ensuring that the site is secure and conducive to healing.
• Step 7: Postoperative Care Instructions - The patient is provided with detailed postoperative care instructions, including guidelines for activity restrictions, wound care, and follow-up appointments to monitor healing.

3. Post-Procedure

After the reconstruction procedure coded as CPT® 28344, patients can expect a recovery period that may vary based on the complexity of the surgery and individual healing responses. Postoperative care typically includes monitoring for signs of infection, managing pain with prescribed medications, and following specific instructions regarding weight-bearing activities. Patients are often advised to keep the surgical site clean and dry, and to attend follow-up appointments for assessment of healing and function. Rehabilitation may be necessary to restore mobility and strength in the affected foot, particularly in cases of central polydactyly where the reconstruction is more extensive. The overall goal of postoperative care is to ensure optimal recovery and functionality of the reconstructed digit.