Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon
CPT4 code
Name of the Procedure:
Transfer or Transplant of Tendon in the Carpometacarpal Area or Dorsum of Hand; without free graft, each tendon
Summary
A surgical procedure in which a tendon is relocated or transplanted in the area where the wrist bones meet the hand bones (carpometacarpal area) or over the back (dorsum) of the hand. The operation doesn’t involve using a tendon graft from another part of the body.
Purpose
This procedure is aimed at restoring lost hand function due to tendon injury, rupture, or disease. The primary goal is to improve hand and finger movement and enhance the patient’s ability to perform daily activities.
Indications
- Significant tendon damage or rupture in the dorsum or carpometacarpal area of the hand.
- Chronic conditions like rheumatoid arthritis that have led to tendon degradation.
- Patients with congenital tendon abnormalities.
Preparation
- Fasting may be required if general anesthesia is used.
- Adjustments to current medications, especially blood thinners.
- Pre-procedure imaging tests like X-rays or MRIs to assess tendon and bone condition.
- Preoperative evaluation, including lab tests and a physical exam.
Procedure Description
- The patient receives anesthesia (local or general) to ensure they are comfortable and pain-free.
- The surgeon makes an incision over the target tendon area.
- The damaged tendon is carefully isolated.
- The tendon is transplanted or transferred to the new position without using a graft from another location.
- The tendon is secured in place with sutures or small screws.
- The incision is closed with stitches and covered with a sterile dressing.
Specialized instruments such as scalpels, retractors, and suture materials are used. Anesthesia may vary from local (numbing the hand) to general (putting the patient to sleep), depending on the case complexity and patient preference.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
This surgery is usually performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic or hand surgeon
- Surgical nurses
- Anesthesiologist or anesthetist
Risks and Complications
- Infection at the incision site
- Nerve damage leading to numbness or weakness
- Tendon re-rupture or failure to achieve desired movement
- Blood clots
- Adverse reactions to anesthesia
Benefits
- Restoration of hand and finger movement
- Increased strength and coordination
- Improved ability to perform daily tasks and quality of life improvement
- Results may be noticeable within a few weeks post-surgery
Recovery
- Keep the hand elevated to reduce swelling.
- Pain management with prescribed medications.
- Regular wound care and keeping the incision dry.
- Physical therapy may be necessary to regain strength and movement.
- Full recovery can take several weeks to months, with regular follow-up appointments to monitor progress.
Alternatives
- Non-surgical treatments like physical therapy and splinting.
- Use of prosthetics or adaptive devices.
- Other surgical options, such as tendon grafting or joint fusion.
Each alternative varies in effectiveness, recovery time, and suitability depending on the specific condition.
Patient Experience
- During the procedure: Minimal discomfort due to anesthesia.
- After the procedure: Pain and swelling managed with medications.
- Rehabilitation: Physical therapy sessions to aid recovery, which may involve some discomfort.
- Overall: Patients may feel gradual improvement in hand function and comfort over time.