CPT® Code 27888

Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nerves

Amputation through the malleoli of the tibia and fibula, specifically procedures such as Syme or Pirogoff, involves the surgical removal of the foot at the ankle joint. This procedure is typically indicated for patients suffering from severe injuries, vascular insufficiency, or infections affecting the forefoot. The term "malleoli" refers to the bony prominences on either side of the ankle, which are critical landmarks during the surgical process. The procedure begins with careful marking of incision lines on the skin to ensure precision. Following this, the surgeon incises the skin and underlying soft tissues, allowing access to the deeper structures. Dissection continues down to the muscle layers, where muscle compartments are identified, isolated, and divided to facilitate the removal of the foot. During this process, neurovascular structures, including nerves and blood vessels, are meticulously identified and isolated. It is crucial to separate the nerves from the arteries to prevent any pulsatile irritation that could lead to complications. The surgical team then excises the forefoot, midfoot, talus, and calcaneus while taking care to preserve the heel pad, which is essential for post-operative weight-bearing. The procedure also involves incising the periosteum of the tibia and fibula just below the malleoli, followed by the elevation of lateral and medial osteoperiosteal flaps. The bone is subsequently resected, and the periosteal flaps are sutured over the remaining tibia and fibula. Finally, the plantar fat and skin pad are rotated and sutured over the end of the tibia and fibula, creating a sensate weight-bearing surface that aids in the patient's recovery and rehabilitation.