27691 Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)

Name of the Procedure:

Transfer or Transplant of Single Tendon (with Muscle Redirection or Rerouting); Deep

• Anterior Tibial or Posterior Tibial Through Interosseous Space
• Flexor Digitorum Longus, Flexor Hallucis Longus, or Peroneal Tendon to Midfoot or Hindfoot

Summary

This surgical procedure involves transferring or transplanting a single tendon, along with its muscle, to a new position in the foot or ankle. The goal is to improve function and stability by redirecting or rerouting tendons such as the anterior tibial, posterior tibial, flexor digitorum longus, flexor hallucis longus, or peroneal tendon.

Purpose

This procedure addresses conditions that involve tendon dysfunction or muscle imbalance in the foot or ankle. The primary goal is to restore proper muscle function, improve stability, alleviate pain, and enhance overall mobility.

Indications

• Tendon injuries or ruptures
• Muscle imbalances causing foot or ankle instability
• Certain types of foot drop
• Residual or recurrent clubfoot
• Charcot-Marie-Tooth disease
• Specific types of tendonitis or tendinopathy

Preparation

• Patients may be instructed to fast for several hours prior to the procedure.
• Medication adjustments, particularly for blood thinners, may be required.
• Preoperative imaging studies like X-rays, MRI, or ultrasound may be performed.
• Physical examination to assess the affected area.

Procedure Description

1. The patient is given anesthesia, typically general or regional.
2. A surgical incision is made to expose the targeted tendon and muscle.
3. The tendon is carefully detached from its original insertion point.
4. The tendon is then redirected or rerouted through an appropriate pathway, which may involve passing through spaces between bones (interosseous spaces).
5. The tendon is re-attached to a new insertion point in the midfoot or hindfoot.
6. The surgical site is closed with sutures, and a protective dressing is applied.

Duration

The procedure typically takes around 1-3 hours, depending on the complexity and specific circumstances of the case.

Setting

The procedure is performed in a hospital's operating room or at a specialized surgical center.

Personnel

• Orthopedic or podiatric surgeon
• Surgical nurses
• Anesthesiologist
• Technicians

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Tendon re-rupture
• Incomplete or over-correction of the original issue
• Postoperative stiffness or scarring

Benefits

• Improved foot and ankle function
• Increased stability
• Reduced pain
• Enhanced mobility
• Correction of muscle imbalance

Recovery

• Postoperative immobilization with a cast or splint for several weeks.
• Gradual weight-bearing as tolerated and as advised by the surgeon.
• Physical therapy to restore strength and flexibility.
• Follow-up appointments to monitor healing progress.
• Full recovery can take several months, with activity restrictions during this time.

Alternatives

• Non-surgical treatments, such as physical therapy or orthotic devices, for less severe cases.
• Other surgical options, such as tendon repair or different tendon transfer techniques.
• Pros and cons should be discussed with the healthcare provider to choose the most suitable approach.

Patient Experience

• Patients are under anesthesia during the procedure and will not feel pain.
• Mild to moderate pain and swelling in the postoperative period, managed with pain medications.
• Initial discomfort transitioning to weight-bearing and mobility exercises.
• Supportive measures like crutches, walkers, or physical therapy aids are often needed during recovery.

Pain management strategies and comfort measures are crucial in facilitating a smooth recovery and ensuring positive outcomes for patients undergoing tendon transfer or transplant procedures.