20924 Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)

Name of the Procedure:

Tendon Graft

• Common Names: Tendon Transfer, Tendon Transplantation
• Technical Terms: Autologous Tendon Graft, Tendon Harvesting from a Distance

Summary

A tendon graft procedure involves taking a healthy tendon from another part of the body (such as the wrist, foot, or leg) to repair or replace a damaged one. This helps restore function and movement to the affected area.

Purpose

The procedure addresses tendon injuries or ruptures that cause loss of function or movement in the affected limb. The goal is to restore strength, flexibility, and function through the transplantation of healthy tendon tissue.

Indications

• Severe tendon injuries or tears
• Tendon degeneration or chronic inflammation that hasn’t responded to conservative treatments
• Loss of muscle function due to tendon loss
• Conditions such as Achilles tendon ruptures, wrist drop, or other orthopedic injuries

Preparation

• Pre-procedure fasting may be required, typically for 6-8 hours.
• Medication adjustments, particularly blood thinners, may be necessary.
• Pre-operative imaging (like MRI or ultrasound) to assess the condition of the tendons.

• Blood tests and general health assessment to ensure the patient is fit for surgery.

  Procedure Description

  1. Anesthesia: Typically performed under general anesthesia.
  2. Incision: The surgeon makes an incision at the donor tendon site (e.g., wrist for palmaris longus, leg for plantaris or foot for toe extensor).
  3. Harvesting: The healthy tendon is carefully removed from its attachment.
  4. Transfer: An incision is made at the site of the damaged tendon. The harvested tendon is then grafted and sewn into place.
  5. Closing: Both the donor and recipient sites are closed with sutures or staples.
  6. Immobilization: The affected area may be immobilized with a cast or splint to support healing.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity and surgical technique.

Setting

Usually performed in a hospital or a specialized surgical center equipped with necessary surgical facilities.

Personnel

• Orthopedic Surgeon or Plastic Surgeon
• Surgical Nurses
• Anesthesiologist
• Surgical Technicians

Risks and Complications

• Infection at the incision sites
• Bleeding or hematoma formation
• Nerve damage leading to numbness or weakness
• Failure of the graft to heal or integrate
• Reduced movement or stiffness
• Allergic reaction to anesthesia

Benefits

• Restores tendon function and movement
• Alleviates pain associated with tendon damage
• Improved quality of life with better limb functionality
• Usually noticeable improvements within a few weeks post-surgery

Recovery

• Pain management through medications
• Immobilization of the graft site for a few weeks
• Physical therapy to regain strength and function
• Full recovery can take several weeks to months depending on individual healing rates
• Follow-up appointments to monitor recovery progress

Alternatives

• Non-surgical treatments like physical therapy, orthotics, or bracing
• Other surgical procedures like direct tendon repair or synthetic grafts
• Each alternative varies in effectiveness depending on the severity and location of the tendon injury

Patient Experience

• During: Since general anesthesia is typically used, the patient should feel no pain during the surgery.
• After: Initial pain and discomfort are to be expected. Pain management strategies include medications and ice applications.
• Physical therapy: Essential to restore movement and strength; it helps enhance recovery and regain pre-injury levels of activity.