26483 Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes obtaining graft), each tendon

Name of the Procedure:

• Common Name: Tendon Transfer Surgery
• Medical Term: Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (including obtaining graft), each tendon

Summary

Tendon transfer surgery involves relocating a tendon from one part of the body to replace a damaged or non-functional tendon in the carpometacarpal area (the joint between the wrist and the fingers) or the dorsum (back) of the hand. The procedure includes harvesting a healthy tendon from another part of the body to use as a graft.

Purpose

The procedure aims to restore movement and function to the hand and fingers when tendons are damaged due to injury, disease, or congenital conditions. By transferring a healthy tendon, patients can regain the ability to grip, pinch, and perform other hand movements.

Indications

• Severe tendon laceration or rupture
• Tendon damage from rheumatoid arthritis or other inflammatory diseases
• Congenital tendon abnormalities
• Nerve injury resulting in tendon paralysis
• Failed previous tendon repair surgeries

Preparation

• Pre-operative fasting for at least 8 hours if general anesthesia is used.
• Adjustment or discontinuation of certain medications, such as blood thinners, as advised by the physician.
• Diagnostic tests such as X-rays, MRI, or ultrasound to assess the condition of the tendons and surrounding structures.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision and Exposure: An incision is made over the affected area to expose the damaged tendon.
3. Tendon Harvesting: A healthy tendon is harvested from a donor site, which is typically another part of the patient's hand, wrist, or forearm.
4. Tendon Transfer: The healthy tendon is then carefully transferred and attached to the affected site using sutures, and it is positioned to replicate the function of the original tendon.
5. Wound Closure: The incisions are closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes 1.5 to 3 hours, depending on the complexity and number of tendons involved.

Setting

The procedure is performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic or Hand Surgeon
• Surgical Nurse
• Anesthesiologist
• Surgical Technician

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Tendon graft failure or rejection
• Reduced hand strength or flexibility
• Nerve damage causing numbness or pain
• Scarring

Benefits

• Restoration of hand and finger movement
• Improved grip strength and dexterity
• Enhanced quality of life and ability to perform daily tasks
• Pain relief from tendon-related issues

Recovery

• Immobilization of the hand using a splint or cast for several weeks to allow healing.
• Pain management with prescribed medications.
• Physical therapy to restore strength and flexibility.
• Full recovery typically takes 3 to 6 months, depending on adherence to rehabilitation guidelines.

Alternatives

• Non-surgical treatments such as physical therapy, braces, or medications
• Tendon repair without grafting (suitable for minor injuries)
• Use of synthetic grafts in cases where autologous (patient's own) tendons are not available

Patient Experience

• Patients may feel discomfort or pain immediately after the procedure, which can be managed with medications.
• Swelling and bruising around the surgical site are common.
• Patients will experience a period of immobilization, followed by gradual return to movement with physical therapy.
• Full functional recovery and pain relief can be expected within several months.