25430 Insertion of vascular pedicle into carpal bone (eg, Hori procedure)

Name of the Procedure:

Insertion of vascular pedicle into carpal bone (e.g., Hori procedure)

Summary

The insertion of a vascular pedicle into a carpal bone, also known as the Hori procedure, is a surgical technique used to treat certain conditions of the wrist bones. It involves transplanting a segment of bone with its blood supply (vascular pedicle) from another part of the body to the affected carpal bone to promote healing and improve blood flow.

Purpose

The procedure is primarily used to treat avascular necrosis (bone death due to lack of blood supply) of the carpal bones, especially the lunate and scaphoid bones. The goal is to restore blood flow, promote bone healing, reduce pain, and restore wrist function.

Indications

• Persistent wrist pain due to avascular necrosis of carpal bones.
• Non-union of scaphoid fractures.
• Patients not responding to conservative treatments like immobilization or medication.
• Adequate vascular pedicle for transplantation.

Preparation

• Pre-operative fasting as instructed by the healthcare provider.
• Discontinuation or adjustment of certain medications (e.g., blood thinners).
• Pre-operative diagnostic tests, such as MRI or CT scan, to assess bone condition and plan the surgery.
• Pre-surgical briefing to discuss the procedure, its risks, and benefits.

Procedure Description

1. Anesthesia: The patient is typically placed under general anesthesia.
2. Incision: A surgical incision is made in the wrist region to access the carpal bones.
3. Harvesting Vascular Pedicle: A segment of bone with its attached blood vessels is harvested from a nearby area, often the radius or another suitable donor site.
4. Insertion: The vascular pedicle is carefully transplanted into the affected carpal bone.
5. Fixation: The transplanted bone is stabilized using screws or other fixation devices.
6. Closure: The incision is closed with sutures, and a sterile dressing is applied.
7. Immobilization: The wrist is often immobilized in a cast or splint.

Tools and Equipment: Surgical scalpel, fixation devices (screws, plates), surgical microscope for precision, and suturing materials.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the case.

Setting

The surgery is performed in a hospital or a specialized surgical center.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Non-union or delayed union of the transplanted bone
• Damage to surrounding nerves or blood vessels
• Persistent pain or stiffness
• Complications related to anesthesia

Benefits

• Improved blood flow and healing of the affected carpal bone
• Pain relief
• Restoration of wrist function
• Prevention of further bone deterioration

Recovery

• Post-operative immobilization in a cast or splint for a recommended period.
• Follow-up appointments to monitor healing and remove sutures.
• Physical therapy to restore movement and strength.
• Recovery time varies but generally takes several weeks to a few months.
• Restrictions on certain activities until full healing is achieved.

Alternatives

• Conservative treatments such as immobilization, medication, and physical therapy.
• Other surgical options like bone grafting without vascular attachment or partial wrist fusion.
• Each alternative has its own risks and benefits; non-surgical options may offer less invasive measures but may not be as effective for advanced bone necrosis.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel pain.
• After the procedure: Pain at the surgical site managed with prescribed pain medications.
• Swelling and discomfort are expected initially; these diminish over time.
• Regular follow-up and adherence to rehabilitation are crucial for optimal recovery.