Flap; neurovascular pedicle
CPT4 code
Name of the Procedure:
Flap; Neurovascular Pedicle
Summary
A neurovascular pedicle flap procedure is a surgical technique where a piece of tissue connected to blood vessels and nerves (pedicle) is moved from one part of the body to another to repair or reconstruct damaged areas. This method ensures that the transplanted tissue maintains its blood supply, promoting better healing and function.
Purpose
The procedure addresses tissue loss or damage due to injury, infection, or surgical removal (e.g., tumor excision). The goal is to restore the form and function of the affected area, enabling better movement, sensation, and appearance.
Indications
- Large soft-tissue defects
- Chronic non-healing wounds
- Reconstruction post-tumor removal
- Traumatic injuries requiring extensive repair
- Conditions where maintaining blood supply to the transplanted tissue is critical
Preparation
- Pre-procedure fasting (typically 8 hours before surgery)
- Medication adjustments as advised by the surgeon
- Pre-operative imaging (e.g., MRI, CT scan) to assess the donor and recipient sites
- Blood tests and overall health assessment to ensure patient suitability for surgery
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made at the donor site to harvest the flap.
- Dissection: The tissue, along with its blood vessels and nerves, is carefully dissected.
- Transfer: The flap is tunneled or positioned to the recipient site.
- Attachment: Blood vessels and nerves are reconnected to the tissue at the recipient site.
- Closure: Incisions at both the donor and recipient sites are closed with sutures.
Tools and Equipment: Surgical scalpel, microsurgical instruments, sutures, electrocautery device.
Duration
The procedure typically takes 3 to 6 hours, depending on the complexity and size of the flap.
Setting
Hospital operating room equipped for microsurgery.
Personnel
- Surgeon specialized in reconstructive microsurgery
- Surgical assistants or nurses
- Anesthesiologist
- Operating room technicians
Risks and Complications
- Infection at the donor or recipient sites
- Flap failure due to insufficient blood supply
- Nerve damage affecting sensation or movement
- Hematoma or seroma formation
- Scarring
- Need for additional surgeries
Benefits
- Restoration of form and function to the affected area
- Improved aesthetic appearance
- Enhanced healing of chronic wounds
- Better functional outcomes due to maintained blood supply and nerve connections
Recovery
- Post-surgical monitoring in the hospital for a few days
- Pain management with medications
- Keeping the surgical sites clean and dry
- Limited movement to allow healing of the flap
- Follow-up visits for suture removal and progress assessment
- Full recovery may take several weeks to months depending on the extent of surgery.
Alternatives
- Skin grafts: Simpler but may lack the same functional benefits.
- Free flaps: Require more complex surgery with higher risk of failure.
- Prosthetics or synthetic implants: Useful for certain defects, but may not integrate as well as natural tissue.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel anything. Post-operatively, patients might experience discomfort and pain, manageable with prescribed medication. Mobility might be restricted initially, with gradual improvement as healing progresses.