CPT® Code 26952

Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood)

An amputation of the finger or thumb, as described by CPT® Code 26952, involves the surgical removal of all or part of the digit due to various medical conditions such as severe trauma, infection, or malignant tumors. This procedure can be performed at specific anatomical locations, including the interphalangeal (IP) joints or the metacarpophalangeal (MCP) joints, or through the phalanges themselves. The surgical process begins with a skin incision made at the predetermined level of amputation. Following the incision, the surrounding soft tissues are carefully dissected to expose the joint or phalanx that is to be removed. During the procedure, tendons may be detached or divided and subsequently reattached to the remaining bone as necessary. A critical aspect of this surgery is the management of digital nerves, which are longitudinally distracted distally and transected in a technique known as traction neurectomy. This technique is designed to minimize the risk of neuroma formation by allowing the nerve end to retract proximally, positioning it 1-1.5 cm from the end of the stump. Blood vessels are also addressed during the procedure, being suture ligated and divided or cauterized to control bleeding. If the amputation occurs at the joint, the joint structures are dissected, and the finger is completely severed, while the articular cartilage is preserved on the remaining bone to cushion it. In cases where the amputation is performed through one of the phalanges, a small bone saw is utilized to cut the bone at the desired level, and the bone end is smoothed using a rongeur or file. Unlike the procedure described in CPT® Code 26951, where the overlying soft tissues are closed in layers, CPT® Code 26952 involves the development of a local advancement flap to cover the stump. Various types of flaps may be employed, including fillet flaps, volar V-Y flaps, bilateral V-Y flaps, and homodigital island flaps, to ensure optimal healing and aesthetic outcomes.