Nerve repair; with nerve allograft, each nerve, first strand (cable)
CPT4 code
Name of the Procedure:
Nerve repair with nerve allograft, each nerve, first strand (cable)
Summary
Nerve repair with nerve allograft involves using a donated nerve tissue (allograft) to repair a damaged nerve. This ensures that the nerve can regenerate and restore function.
Purpose
This procedure addresses nerve damage or severance, which can result from injuries or surgeries. The goal is to restore nerve function, reduce pain, and regain movement and sensation in the affected area.
Indications
- Nerve injuries or severances from accidents or trauma.
- Chronic nerve pain or dysfunction.
- Surgical damage to nerves.
- Patients with insufficient or unsuitable nerve tissue for autografting.
Preparation
- Fasting for 6-8 hours prior if general anesthesia is used.
- Adjusting or stopping certain medications as advised by the doctor.
- Preoperative imaging or nerve conduction studies to assess the extent of nerve damage.
Procedure Description
- Anesthesia: The patient is administered general anesthesia or local anesthesia with sedation.
- Exposure: The surgeon makes an incision to access the damaged nerve.
- Preparation of Nerve Ends: The damaged nerve ends are prepared for grafting by trimming any scar tissue.
- Graft Placement: A segment of nerve allograft is carefully positioned between the cut ends of the nerve.
- Securing the Graft: The allograft is sutured in place; microsurgical techniques are often used.
- Closing the Incision: The surgical site is closed with sutures or staples, and a sterile dressing is applied.
Tools & Equipment:
- Microsurgical instruments.
- Nerve allograft (donated nerve tissue).
Duration
The procedure typically takes about 2 to 4 hours, depending on the complexity and site of the nerve damage.
Setting
The procedure is performed in a hospital's operating room or a specialized surgical center.
Personnel
- Surgeon (usually a nerve or plastic surgeon)
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection at the surgical site.
- Rejection of the allograft.
- Incomplete nerve regeneration.
- Pain or discomfort at the graft site.
- Nerve dysfunction or numbness.
- Scar tissue formation.
Benefits
- Restoration of sensation and motor function.
- Reduction of pain associated with nerve damage.
- Improved quality of life and functionality.
Recovery
- Initial post-operative monitoring in the hospital.
- Pain management with prescribed medications.
- Restrictions on movement to promote healing.
- Physical therapy and rehabilitation exercises.
- Follow-up appointments to monitor nerve regeneration and function.
- Full recovery can take several months to a year, depending on the extent of the nerve damage and the patient's overall health.
Alternatives
- Autograft (using the patient’s own nerve tissue)
- Pros: No risk of rejection.
- Cons: Requires additional surgical site, potential donor site morbidity.
- Nerve conduits or tubes.
- Pros: Less invasive, no donor site needed.
- Cons: May not be suitable for larger or more complex nerve injuries.
Patient Experience
During the procedure, the patient will be asleep or sedated and should not feel any pain. Post-operatively, there may be some pain and discomfort that can be managed with medication. Patients may feel tingling or numbness as the nerve regenerates. Comfort measures include adequate pain relief, careful monitoring, and support during recovery through physical therapy and follow-up care.