Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendon
CPT4 code
Name of the Procedure:
Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendon. Common Names: Palmar Tendon Transfer, Tendon Grafting, Tendon Transplant.
Summary
The procedure involves transferring or transplanting a tendon in the palm using a free tendon graft. This means that a tendon is taken from another part of the body (donor site) and used to replace or support a damaged tendon in the palm. It aims to restore movement and function to the hand.
Purpose
Medical Condition/Problem Addressed: Traumatic tendon injuries, chronic tendon injuries, tendon ruptures, congenital tendon defects, or conditions causing loss of tendon function in the hand.
Goals/Outcomes: Restoring hand function, improving strength and dexterity in the affected hand, reducing pain and disability, and enhancing the patient's quality of life.
Indications
Symptoms/Conditions:
- Significant tendon damage or rupture in the palm.
- Decreased hand function due to tendon issues.
- Chronic pain and disability from tendon injuries.
- Conditions like Dupuytren's contracture.
Patient Criteria:
- Patients with non-repairable tendons.
- Suitable donor sites available for tendon grafting.
- Overall good health to tolerate surgery.
Preparation
- Patients may need to fast for a few hours before the procedure.
- Avoid certain medications as instructed by the surgeon.
- Blood tests, imaging studies (like X-rays or MRIs), and physical assessments to evaluate the condition and plan the surgery.
Procedure Description
- Anesthesia: General or regional anesthesia is provided to minimize pain and ensure the patient is comfortable.
- Incision: An incision is made in the palm to access the damaged tendon.
- Harvesting Graft: A tendon is harvested from a suitable donor site (commonly from the forearm or leg).
- Transplantation: The harvested tendon is carefully placed and secured in the damaged area.
- Stitching: The new tendon is anchored into place, and the incisions are closed with sutures.
- Bandaging: The hand is bandaged and immobilized to support healing.
Tools/Equipment: Surgical instruments for cutting and suturing, graft harvest tools, anesthesia equipment.
Duration
The procedure typically takes 1.5 to 3 hours, depending on the complexity and specific case.
Setting
Performed in a hospital or an outpatient surgical center equipped for hand surgery.
Personnel
- Orthopedic or hand surgeon
- Surgical nurses
- Anesthesiologist/Anesthesia nurse
Risks and Complications
Common Risks: Infection, bleeding, pain, swelling. Rare Risks: Nerve damage, graft failure, reduced hand function, allergic reactions to anesthesia.
Complication Management: Immediate medical attention, antibiotics for infection, physical therapy for rehabilitation.
Benefits
- Restored hand function and movement.
- Reduced pain and increased strength.
- Improved quality of life.
Realization of Benefits: Benefits can be realized within a few weeks to months post-surgery, with improvement continuing as the hand heals and undergoes rehabilitation.
Recovery
- Follow postoperative care instructions (e.g., keeping the hand elevated, wound care).
- Physical therapy to regain strength and flexibility.
- Expected recovery time is typically 6 weeks to several months, depending on the extent of surgery and individual healing rate.
- Restrictions on heavy lifting and certain activities until cleared by the surgeon.
- Follow-up appointments for monitoring progress.
Alternatives
Other Treatment Options:
- Non-surgical methods like splinting or physical therapy for minor injuries.
- Steroid injections to reduce inflammation.
- Alternative surgeries might be considered depending on the specific case.
Pros/Cons of Alternatives: Non-surgical options have fewer risks but may not be effective for severe tendon damage. Alternative surgeries may vary in complexity and recovery time.
Patient Experience
During Procedure:
- Under anesthesia, ensuring no pain during surgery.
- Sedation or general anesthesia to ensure comfort.
After Procedure:
- Some pain and discomfort which can be managed with prescribed pain medications.
- Hand may be immobilized initially.
- Physical therapy is crucial for recovery.
- Gradual return to regular activities as per physician’s advice.
Pain management techniques, like medications and proper immobilization, play a significant role in improving comfort during recovery.