26426 Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each finger

Name of the Procedure:

Repair of Extensor Tendon, Central Slip, Secondary (e.g., Boutonniere Deformity); Using Local Tissue(s), Including Lateral Band(s), Each Finger

Summary

This procedure involves surgically repairing a damaged extensor tendon in the finger, specifically the central slip. This tendon injury can cause a boutonniere deformity, where the finger's middle joint bends downwards while the end joint bends upwards. The repair uses local tissues, including lateral bands, to restore function and appearance to the affected finger.

Purpose

The goal of this surgery is to correct the boutonniere deformity, restoring proper alignment and functionality to the finger. This will enable the patient to regain normal finger movements, improving their ability to perform daily tasks and activities involving the hands.

Indications

• Presence of a boutonniere deformity
• Inability to fully straighten the middle joint of the finger
• Pain and discomfort in the affected finger
• Impaired hand function affecting the patient's daily activities

Preparation

• Patients may be advised to fast for several hours before the procedure if general anesthesia is used.
• Adjustments to current medications, particularly blood thinners.
• Preoperative imaging tests (e.g., X-rays) and assessments to evaluate the extent of tendon damage.

Procedure Description

1. The procedure is typically performed under local or regional anesthesia, although general anesthesia may be used in some cases.
2. The surgeon makes an incision over the affected finger to access the damaged tendon.
3. Using local tissue or the lateral bands, the surgeon repairs the central slip of the extensor tendon.
4. The repaired tendon is secured in place to ensure proper alignment.
5. The incision is closed with sutures, and a bandage or splint is applied to protect the repair.

Duration

The procedure usually takes about 1 to 1.5 hours, depending on the extent of the injury and the complexity of the repair.

Setting

The procedure is commonly performed in an outpatient surgical center or hospital operating room.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Nerve damage leading to numbness or weakness
• Stiffness or loss of motion in the finger
• Failure of the tendon repair, requiring additional surgery

Benefits

• Restoration of normal finger alignment and function
• Reduced pain and discomfort
• Improved ability to perform daily activities
• Enhanced overall hand function and dexterity

Recovery

• Post-procedure care includes keeping the finger clean and dry, and wearing a splint as directed.
• Physical therapy exercises may be needed to regain strength and mobility.
• Recovery time varies but typically ranges from several weeks to a few months.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Non-surgical treatments such as splinting or physical therapy, though these may not be effective for severe cases.
• Corticosteroid injections to reduce inflammation and pain.

Patient Experience

During the procedure, the patient may feel pressure but should not experience pain due to anesthesia. Post-surgery, there may be some discomfort and swelling, which can be managed with pain medications and ice packs. Full recovery involves a gradual return to normal activities, guided by healthcare providers.