25312 Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon

Name of the Procedure:

Tendon Transplantation or Transfer, Flexor or Extensor, Forearm and/or Wrist, Single; with Tendon Graft(s) (includes obtaining graft), each Tendon

Summary

Tendon transplantation or transfer involves relocating or reconstructing a tendon in the forearm or wrist using a tendon graft. This graft can be taken from another part of the patient's body to repair or replace the damaged tendon.

Purpose

This procedure addresses injuries or conditions that have damaged the tendons in the forearm or wrist, impairing movement and function. The goal is to restore normal function, improve mobility, and reduce pain.

Indications

• Severe tendon injuries
• Tendon lacerations
• Tendon ruptures
• Chronic tendonitis or tenosynovitis
• Nerve injuries causing muscle or tendon damage
• Congenital abnormalities affecting tendon function

Preparation

• Fasting for 8-12 hours before the procedure if general anesthesia is used.
• Adjustments or discontinuation of certain medications, as advised by the surgeon.
• Pre-operative imaging studies, such as MRI or ultrasound, to assess the extent of tendon damage.

Procedure Description

1. Anesthesia is administered (general or regional).
2. An incision is made over the damaged tendon.
3. The damaged tendon is located and carefully dissected.
4. A tendon graft is harvested from another part of the patient's body.
5. The harvested graft is positioned and sutured to replace or supplement the damaged tendon.
6. The surgical site is closed with sutures.
7. A sterile dressing is applied, and a splint or cast may be used to immobilize the area.

Duration

The procedure typically takes 2-4 hours, depending on the complexity and location of the tendon repair.

Setting

The procedure is performed in a hospital or surgical center operating room.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Graft failure or rejection
• Stiffness and reduced mobility in the wrist or forearm
• Blood clots

Benefits

• Restored movement and function of the affected wrist or forearm
• Pain reduction
• Enhanced ability to perform daily activities

Recovery

• Initial immobilization with a splint or cast for several weeks.
• Physical therapy to regain strength and flexibility.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing.
• Expected recovery time varies; full recovery can take several months.

Alternatives

• Physical therapy and rehabilitation
• Splinting or casting without surgery
• Medications for pain and inflammation
• Minimally invasive procedures like tendon repair without graft

Pros and Cons of Alternatives:

• Non-surgical options may yield less dramatic improvements.
• Minimally invasive options might have shorter recovery times but may not be suitable for severe cases.

Patient Experience

During the procedure, patients under general anesthesia will be unconscious and feel no pain. Regional anesthesia will numb the specific area, possibly leaving the patient awake but pain-free.

Post-procedure, patients may experience discomfort and swelling, manageable with pain medications and proper care. The immobilization period will limit activity temporarily, with gradual improvement as physical therapy progresses.