CPT® Code 25905

The CPT® Code 25905 refers to an open, circular (guillotine) amputation of the forearm, specifically through the radius and ulna. This procedure is categorized as a below-elbow amputation, which can be performed at various levels: high, middle, or low, depending on the specific clinical situation and the extent of the amputation required. In a high amputation, the procedure is performed a few centimeters below the elbow joint, while a middle amputation occurs through the shafts of the radius and ulna, and a low amputation is executed a few centimeters above the wrist. The surgical approach involves positioning the patient with the operative side's shoulder slightly elevated to facilitate access to the forearm. During the procedure, the surgeon marks the incision lines on the skin, typically utilizing an anterior/posterior fish-mouth flap technique. The incision is made perpendicular to the skin surface, allowing for the dissection of underlying soft tissue, where blood vessels and nerves are identified and managed. The large blood vessels are mobilized, ligated, and divided, while nerves are carefully handled to prevent damage. The radius and ulna are exposed, and periosteal flaps are created to ensure proper closure after the bones are transected. The procedure emphasizes maintaining equal lengths of the bones and ensuring that the remaining bone structures are adequately enveloped in muscle tissue to promote healing and function post-surgery. The circular amputation technique, as described in this code, involves making skin incisions in a circular manner at the predetermined site, followed by the careful dissection and management of soft tissue, ultimately leading to the closure of the surgical site with a rigid dressing to minimize pain and swelling.