26485 Transfer or transplant of tendon, palmar; without free tendon graft, each tendon

Name of the Procedure:

Transfer or transplant of tendon, palmar; without free tendon graft, each tendon. (Also known as Tendon Transfer Surgery)

Summary

In tendon transfer surgery, a tendon is moved from one location to another in the hand to restore function to a damaged or non-functioning tendon. This specific procedure does not involve the use of a free tendon graft.

Purpose

This procedure is intended to address hand function loss due to tendon injury, rupture, or conditions such as nerve palsies. The goal is to reestablish movement and strength in the affected finger or part of the hand.

Indications

• Tendon injuries or rupture
• Nerve palsies (e.g., ulnar or radial nerve palsy)
• Conditions leading to loss of tendon function (e.g., rheumatoid arthritis)
• Inability to perform specific hand or finger movements

Preparation

• Pre-operative assessment including physical examination and imaging (e.g., X-ray, MRI)
• Discussion of medical history and current medications
• Fasting for 6-8 hours prior to surgery
• Adjustment of medications as advised (e.g., cessation of blood thinners)

Procedure Description

1. Administration of local or general anesthesia.
2. An incision is made in the palm or hand.
3. Identification of the donor tendon (the tendon to be transferred).
4. Detachment of the donor tendon.
5. Routing the donor tendon to the location of the non-functioning tendon.
6. Securing the donor tendon in its new location using sutures.
7. Closing the incision with stitches.
8. Application of a dressing and possibly a splint to keep the hand immobilized.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and number of tendons involved.

Setting

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

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Stiffness or reduced range of motion
• Failure of the tendon transfer to restore function
• Complications from anesthesia

Benefits

Successful tendon transfer can significantly improve hand and finger function, enabling the patient to perform daily activities and tasks. Improvement is typically observed several weeks to a few months post-surgery.

Recovery

• Immobilization of the hand in a splint or cast for a few weeks
• Physical therapy to restore strength and range of motion
• Regular follow-up appointments to monitor healing
• Gradual resumption of normal activities over several months

Alternatives

• Non-surgical treatments such as splinting, physical therapy, or corticosteroid injections
• Other surgical options like tendon grafting or tendon repair
• Pros and cons: Non-surgical treatments may offer relief but may not fully restore function. Other surgical options could be more invasive or require donor materials but might be necessary depending on the specific case.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, there may be discomfort, swelling, and pain managed with prescribed medications. Patients should expect some limitations in hand function during the initial recovery phase and participate in physical therapy to regain strength and movement.