26498 Transfer of tendon to restore intrinsic function; all 4 fingers

Name of the Procedure:

Transfer of tendon to restore intrinsic function; all 4 fingers (Tendon transfer surgery)

Summary

Tendon transfer surgery involves relocating tendons from one part of the body to the fingers to restore their movement and function. This can be particularly beneficial for patients who have lost intrinsic hand functions due to injury or neurological conditions.

Purpose

This procedure aims to improve hand functionality in patients who have weakened or paralyzed intrinsic hand muscles. The goal is to restore the ability to perform fine motor tasks such as gripping, holding objects, and dexterous finger movements.

Indications

• Paralysis or significant weakness of the intrinsic hand muscles due to conditions like brachial plexus injury, stroke, or nerve damage.
• Specific criteria include loss of fine motor skills, difficulty in grip strength, and inefficient hand function in daily activities.

Preparation

• Patients may be required to fast for several hours before the surgery.
• Medication adjustments might be needed, especially if the patient is on blood thinners.
• Pre-procedure evaluations may include imaging tests like MRI or X-rays, as well as nerve conduction studies to assess the extent of muscle and nerve damage.

Procedure Description

1. The patient is administered anesthesia, usually general.
2. The surgeon makes an incision to access the tendons.
3. Tendons are carefully identified, detached from their original insertion, and rerouted to new locations to restore function of the paralyzed fingers.
4. The transferred tendons are securely anchored to their new positions.
5. The surgical site is then closed with sutures, and a protective dressing is applied.
6. The hand is usually immobilized in a splint or cast to support the healing process.

Duration

The procedure typically takes about 2 to 4 hours.

Setting

Transfer of tendons to restore intrinsic function is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic or plastic surgeon specialized in hand surgeries
• Anesthesiologist
• Surgical nurses and technicians
• Physical or occupational therapist (post-operative rehabilitation team)

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clot formation
• Nerve damage leading to altered sensation
• Failure of the transferred tendon to restore function effectively
• Scar tissue formation affecting hand flexibility

Benefits

• Improved hand function such as grasping, pinching, and manipulating objects
• Increased independence in daily activities
• Enhanced quality of life and ability to perform tasks requiring fine motor skills Benefits may be realized within a few months post-surgery, following rehabilitation.

Recovery

• Post-procedure care includes keeping the hand elevated and immobilized.
• Pain management with prescribed medications.
• Specific exercises and physical or occupational therapy to regain strength and flexibility.
• Recovery time can range from several weeks to a few months, with follow-up visits for monitoring progress and adjustments to the rehabilitation plan.

Alternatives

• Physical therapy alone, which may offer limited improvement without surgical intervention.
• Use of orthotic devices to support hand function.
• Injection therapies like corticosteroids to reduce inflammation (though not a long-term solution for muscle function loss).
• Each alternative has its pros and cons, often linked to the severity of muscle dysfunction and patient-specific factors.

Patient Experience

Patients can expect to experience some pain and swelling initially, managed by medications prescribed by the healthcare team. During recovery, physical therapy is crucial and might cause some discomfort but is essential for regaining full function. Dedicated effort in rehabilitation can significantly enhance outcome and overall satisfaction post-surgery.