Finger Amputation
[Traumatic partial amputation / Nonviable finger / Infection / Painful or nonfunctional residual digit / Tumor / Other], [right / left] [index / middle / ring / small] finger at [level]
Same
[Completion / Revision] amputation of the [right / left] [index / middle / ring / small] finger at the [distal phalanx / distal interphalangeal joint / middle phalanx / proximal interphalangeal joint / proximal phalanx] with direct closure
[***, MD/DO]
[Resident/Fellow/PA name]
[General / Regional / Local with monitored anesthesia care]
The patient is a [age]-year-old [male / female] with [traumatic injury / nonviable tissue / infection / a painful residual digit] involving the [right / left] [index / middle / ring / small] finger. Examination and imaging demonstrated [injury level, tissue viability, and bone or joint involvement]. Treatment options, anticipated residual length, risks, benefits, and alternatives were discussed. Informed consent was obtained.
The [right / left] [index / middle / ring / small] finger had a nonviable or injured segment at the [exact level]. The retained skin and subcutaneous tissue were viable and sufficient for direct closure. The flexor and extensor tendons and radial and ulnar digital neurovascular bundles were identified at the amputation level. The retained bone and soft tissue demonstrated healthy bleeding after debridement.
The patient was positioned supine with the operative arm supported on a hand table. After anesthesia was established, the [right / left] upper extremity was prepared and draped in sterile fashion. A surgical time-out confirmed the patient, procedure, side, and finger. [An upper-arm tourniquet was inflated to [pressure] mmHg for [duration] minutes / A digital tourniquet was applied for [duration] minutes / No tourniquet was used.]
The wound was irrigated and inspected. Nonviable skin, subcutaneous tissue, tendon, and bone were excised to healthy tissue. The definitive level preserved functional length while permitting durable, tension-free coverage. The flexor and extensor tendons were delivered distally, divided sharply, and allowed to retract. The digital vessels were controlled.
The radial and ulnar proper digital nerves were identified in healthy tissue, placed under gentle traction, and divided sharply so the ends retracted into a protected soft-tissue bed.
[The involved phalanx was shortened to the planned level with a rongeur. / The involved interphalangeal joint was disarticulated under direct visualization.] Residual bone and prominent condyles were contoured until smooth. The amputated segment was sent to pathology.
The wound was irrigated, the tourniquet was released when used, and hemostasis was confirmed. The available skin was reapproximated directly without undue tension, creating a well-padded viable stump. The wound was closed with [suture], and a soft dressing and protective splint were applied. All counts were correct. The patient tolerated the procedure and was transferred to PACU in stable condition.
None
Amputated [right / left] [index / middle / ring / small] finger to pathology
[*** mL]
None
The patient was transferred to PACU in stable condition.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: [Traumatic partial amputation / Nonviable finger / Infection / Painful or nonfunctional residual digit / Tumor / Other], [right / left] [index / middle / ring / small] finger at [level]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: [Completion / Revision] amputation of the [right / left] [index / middle / ring / small] finger at the [distal phalanx / DIP joint / middle phalanx / PIP joint / proximal phalanx] with direct closure
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: [General / Regional / Local with monitored anesthesia care]
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with [traumatic injury / nonviable tissue / infection / a painful residual digit] involving the [right / left] [index / middle / ring / small] finger. Examination and imaging demonstrated [injury level, tissue viability, and bone or joint involvement]. Treatment options, risks, benefits, and alternatives were discussed, and informed consent was obtained.
FINDINGS: Nonviable or injured tissue at [exact level] of the [right / left] [index / middle / ring / small] finger. The retained skin and subcutaneous tissue were viable and sufficient for direct closure. Retained bone and soft tissue demonstrated healthy bleeding after debridement.
DESCRIPTION OF PROCEDURE:
The patient was positioned supine with the arm supported on a hand table. After anesthesia, the upper extremity was prepared and draped sterilely. A time-out confirmed the patient, procedure, side, and finger. [An upper-arm tourniquet was inflated to *** mmHg for *** minutes / A digital tourniquet was used for *** minutes / No tourniquet was used.]
The wound was irrigated and inspected. Nonviable skin, subcutaneous tissue, tendon, and bone were excised to healthy tissue. The definitive level preserved functional length while permitting durable coverage. The flexor and extensor tendons were delivered distally, divided, and allowed to retract. The digital vessels were controlled.
The radial and ulnar proper digital nerves were placed under gentle traction and divided sharply so the ends retracted into protected tissue. [The involved phalanx was shortened to the planned level with a rongeur. / The involved interphalangeal joint was disarticulated under direct visualization.] Residual bone and prominent condyles were contoured until smooth. The amputated segment was sent to pathology.
The wound was irrigated, the tourniquet was released when used, and hemostasis was confirmed. The available skin was closed directly without undue tension, creating a well-padded viable stump. A soft dressing and protective splint were applied. All counts were correct. The patient tolerated the procedure and was transferred to PACU in stable condition.
ESTIMATED BLOOD LOSS: *** mL
SPECIMENS: Amputated finger to pathology
COMPLICATIONS: None
DRAINS: None
DISPOSITION: PACU in stable condition
Signed: .ME, .MYDEGREE
.TODAYVariants
Distal fingertip revision
Document the defect as transverse, volar-oblique, dorsal-oblique, or irregular; measure the skin and pulp loss; and state whether distal phalanx, tendon insertion, nail bed, or germinal matrix is exposed or injured. Excise nonviable tissue, contour only the bone required for the chosen coverage, and record the residual support beneath the nail bed. State whether the nail complex was preserved, repaired, or completely removed and whether the wound was closed, covered, or managed by secondary healing.
Local advancement-flap closure
Name the local flap used, such as a volar V-Y or bilateral lateral advancement flap, and document its design, dimensions, vascular or neurovascular pedicle, mobilization, advancement, and final perfusion. Record whether any proximal or lateral donor defect was closed or left for secondary healing. A cross-finger or thenar flap is a separate staged reconstruction and should be documented in full rather than represented as a local advancement flap.
Metacarpophalangeal-joint disarticulation
Document the palmar and dorsal flap design, flexor and extensor tendon division, individual management of the proper digital nerves and vessels, capsular and collateral-ligament division, and protection of neurovascular branches supplying adjacent fingers. State whether the metacarpal head or condyles required contouring, how the transverse metacarpal ligament and resulting web space were managed, and whether the closure was padded and tension-free.
Single-ray amputation (advanced)
Identify the removed ray and exact metacarpal osteotomy or disarticulation level. Document flexor, extensor, lumbrical, and interosseous management; division of structures belonging to the removed digit; preservation of common digital branches serving adjacent fingers; and the selected digital-nerve strategy. Describe metacarpal contouring, transverse-metacarpal-ligament or web-space reconstruction, any intrinsic or tendon transfer, the alignment and rotational cascade of the remaining fingers, drain use, and final closure.
Charting Tips
- Identify the hand, finger, and precise level; distinguish transphalangeal amputation from DIP-, PIP-, or MCP-joint disarticulation.
- Describe the mechanism, contamination, tissue viability, and structures exposed or injured before and after debridement.
- When relevant, document whether replantation or revascularization was considered and the patient-specific reason it was not pursued.
- Record tendon, digital-vessel, digital-nerve, and bone management and the final padding and viability of the stump.
- For distal injuries, use the fingertip variant to document the nail complex and residual bony support.
- Use the appropriate separate variant for a local flap, MCP disarticulation, or ray amputation, and document any specimens by source.
Documentation & Reimbursement Considerations
- Report Finger Amputation as the primary service when it is the definitive operation performed.
- Finger amputation with direct closure, amputation closed with a local advancement flap, and removal of a complete ray are distinct reporting categories. Document the closure or reconstruction actually performed.
- These finger-level and single-ray services generally carry a 90-day Medicare global period.
- When more than one finger is treated, identify the side, finger, amputation level, and closure method separately for each digit.
- Bone contouring, tendon and nerve management, and treatment of the nail matrix may be necessary parts of forming the documented stump. Describe the work accurately without presenting an inherent step as an unrelated additional service.