Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); secondary with free graft (includes obtaining graft), each tendon
CPT4 code
Name of the Procedure:
Repair or Advancement of Flexor Tendon, not in Zone 2 Digital Flexor Tendon Sheath (e.g., No Man's Land); Secondary with Free Graft (includes obtaining graft), Each Tendon.
Summary
This surgical procedure involves repairing or advancing a flexor tendon in the hand or wrist, excluding the complex area known as Zone 2. A free tendon graft is used to replace or augment the damaged tendon, and the graft is harvested from another part of the patient's body.
Purpose
The procedure is designed to restore function and movement to a finger or hand affected by a damaged or ruptured flexor tendon. The goal is to improve the range of motion, strength, and dexterity of the affected digit.
Indications
- Ruptured or severely damaged flexor tendons outside of Zone 2.
- Tendons that have not healed properly after initial treatment.
- Loss of function or significant pain in the affected finger or hand.
- Patients who are in suitable health for surgery and have failed non-surgical treatments.
Preparation
- Pre-procedure fasting for a specified number of hours.
- Adjustments to medications, particularly blood thinners.
- Diagnostic imaging such as X-rays or MRI to assess tendon damage.
- Physical examination and medical history review.
Procedure Description
- Administration of appropriate anesthesia (local, regional, or general).
- A small incision is made over the affected area.
- The damaged tendon is carefully identified and exposed.
- A segment of tendon graft is harvested from another site, typically the forearm or ankle.
- The harvested graft is meticulously attached to the ends of the damaged tendon.
- The incision is closed with sutures and a sterile dressing is applied.
- A splint or cast may be used to immobilize the hand and protect the repair.
Duration
The procedure typically takes about 1-2 hours, depending on the complexity.
Setting
The surgery is performed in a hospital or an outpatient surgical center.
Personnel
The surgical team includes:
- An orthopedic or hand surgeon.
- Surgical nurses.
- An anesthesiologist or nurse anesthetist.
- Surgical assistants.
Risks and Complications
- Infection at the incision site.
- Excessive bleeding or hematoma formation.
- Nerve damage leading to numbness or weakness.
- Failure of the graft to integrate with the original tendon.
- Stiffness or reduced range of motion post-surgery.
- Allergic reactions to anesthesia.
Benefits
- Restoration of tendon function and hand movement.
- Relief from pain associated with a damaged tendon.
- Improved hand strength and dexterity.
- Return to daily activities and occupational tasks.
Recovery
- Initial immobilization of the hand using a splint or cast.
- Pain management with prescribed medications.
- Physical therapy to regain motion and strength, starting a few weeks post-surgery.
- Full recovery may take several months, with gradual improvement over time.
- Follow-up appointments to monitor healing progress.
Alternatives
- Non-surgical treatments such as physical therapy, splinting, or medications.
- Other surgical options like primary tendon repair without a graft or tendon transfer.
- Pros of alternatives: Non-invasive options may pose fewer risks.
- Cons of alternatives: May be less effective for severe tendon damage.
Patient Experience
During the procedure:
- The patient will be under anesthesia and should not feel pain.
- Post-procedure, mild to moderate pain is expected, managed with pain relief measures.
After the procedure:
- Pain, swelling, and stiffness in the initial recovery period.
- Gradual improvement in hand function and reduction in pain with rehabilitation.
- Close adherence to post-surgical care and physical therapy is crucial for optimal recovery.