64902 Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure)

Name of the Procedure:

Nerve Graft, Each Additional Nerve (Multiple Strands or Cable)

Summary

A nerve graft with multiple strands (also known as a cable graft) involves using sections of nerve from another part of the body to repair damaged nerves. This procedure is performed in addition to a primary nerve repair surgery to enhance the recovery of nerve function.

Purpose

This procedure addresses severe nerve damage where a single strand nerve graft may not be sufficient. The goal is to improve the likelihood of successful nerve regeneration and restore function to affected areas.

Indications

• Severe nerve injuries where a traditional single strand graft is inadequate.
• Nerve damage caused by trauma, surgical injury, or tumors.

• Conditions leading to significant loss of motor or sensory function.

  Preparation

• Patients may need to fast for several hours before the procedure.
• Preoperative assessments include medical history review, physical examination, and diagnostic tests like nerve conduction studies or imaging.
• Medication adjustments may be necessary, especially anticoagulants or other medications affecting healing.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made at the site of the damaged nerve.
3. A segment of nerve (usually from the patient's leg) is harvested.
4. The harvested nerve is divided into multiple strands.
5. These strands are carefully aligned and sutured to the damaged nerve ends.
6. The surgical site is closed with sutures or staples, and the area is bandaged.

Tools/Equipment:

• Microsurgical instruments, including microscissors, microforceps, and suturing materials.
• Operating microscope.
• Anesthesia delivery system.

Anesthesia:

• General anesthesia to ensure the patient is unconscious and pain-free during the procedure.

Duration

Typically, the procedure lasts 3 to 5 hours, depending on the complexity of the nerve repair.

Setting

The procedure is usually performed in a hospital operating room or specialized surgical center.

Personnel

• Lead Surgeon (specialized in microsurgery or nerve repair)
• Surgical Assistants or Nurses
• Anesthesiologist
• Operating Room Technicians

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Scar tissue formation leading to nerve compression.
• Partial or complete failure of the graft, necessitating further surgery.
• Temporary or permanent nerve dysfunction.

Benefits

• Improved chances of nerve regeneration.
• Potential restoration of sensory and motor functions.
• Enhanced quality of life and functional independence.

Recovery

• Postoperative care includes pain management, wound care, and physical therapy.
• Patients may need to avoid strenuous activities for 4–6 weeks.
• Follow-up appointments to monitor recovery and nerve function progress.

Alternatives

• Traditional single strand nerve grafts.
• Conservative management like physical therapy and medications.
• Advanced surgical options like nerve transfers.

Pros and Cons:

• Single strand grafts may be insufficient for severe damage but are less complex.
• Conservative treatments may not yield significant improvement.
• Nerve transfers can be more complex but might offer better outcomes in specific cases.

Patient Experience

Patients can expect to feel sore and experience some pain postoperatively, managed with prescribed analgesics. Swelling and bruising are common but should subside over time. Physical therapy aids recovery and nerve function restoration, and most patients gradually regain strength and sensation in the affected area.