26358 Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon

Name of the Procedure:

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (e.g., no man's land); secondary, with free graft (includes obtaining graft), each tendon.

Summary

This surgical procedure involves repairing or advancing a damaged flexor tendon in the area known as "no man's land" (zone 2) within the finger. It includes using a free graft to restore tendon function.

Purpose

The primary goal of this procedure is to restore normal movement and flexibility to a finger with a damaged flexor tendon. It addresses the problem of a torn or severely damaged tendon that impedes the bending of the finger.

Indications

• Severe lacerations or rupture of the flexor tendons in zone 2 of the finger.
• Significant loss of finger movement and flexibility.
• Patients who have not responded to non-surgical treatments and therapies.

Preparation

• The patient may be asked to fast for a certain period before the procedure.
• Medications that increase bleeding risk may need to be adjusted.
• Preoperative assessments may include imaging tests like MRI or ultrasound to determine the extent of tendon damage.

Procedure Description

1. The patient is given general or regional anesthesia to ensure comfort.
2. A surgical incision is made in the finger to access the damaged tendon.
3. The damaged portions of the tendon are carefully removed or repaired.
4. A free tendon graft is harvested from another part of the body, often the wrist or forearm.
5. The graft is then sewn into place to bridge the gap or replace the damaged tendon.
6. The incision is closed, and a bandage or splint is applied to protect the site.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

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

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection at the surgical site.
• Nerve damage leading to numbness or tingling.
• Stiffness or loss of motion in the finger.
• Graft rejection or failure.
• Blood clots.

Benefits

• Restoration of finger movement and function.
• Reduction of pain and discomfort.
• Improved overall hand function.
• Benefits may be realized within a few weeks to months post-surgery.

Recovery

• The finger will be immobilized in a splint for several weeks.
• Physical therapy will be necessary to restore strength and mobility.
• Follow-up appointments to monitor healing and progress.
• Full recovery may take several months, depending on individual factors.

Alternatives

• Non-surgical treatments, such as splinting and physical therapy.
• Tendon transfers (using other tendons to restore finger function).
• Prosthetic devices for finger support.
• Surgical risks and benefits should be weighed against these alternatives with your healthcare provider.

Patient Experience

• The patient will be under anesthesia during the procedure and may feel minimal discomfort.
• Post-surgery, there may be some pain and swelling managed with medications.
• Engaging in physical therapy will aid in recovery and improve outcomes.
• Gradual improvement in finger movement and strength can be expected as recovery progresses.