Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes obtaining graft), each tendon
CPT4 code
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
- Anesthesia: General or regional anesthesia is administered.
- Incision and Exposure: An incision is made over the affected area to expose the damaged tendon.
- Tendon Harvesting: A healthy tendon is harvested from a donor site, which is typically another part of the patient's hand, wrist, or forearm.
- 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.
- 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.