Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)
CPT4 code
Name of the Procedure:
Transfer or Transplant of Single Tendon with Muscle Redirection or Rerouting; Superficial (e.g., Anterior Tibial Extensors into Midfoot)
Summary
This procedure involves the surgical transfer or transplant of a tendon along with the redirection or rerouting of its muscle to improve or restore function. In this specific case, the anterior tibial extensor tendons are moved to a new position in the midfoot.
Purpose
This surgery is designed to address dysfunctions or deformities in the foot caused by conditions like drop foot, muscle imbalance, or injuries. It aims to improve mobility, balance, and overall foot function.
Indications
- Drop foot due to nerve damage or muscle weakness
- Tendon injuries or ruptures
- Congenital deformities affecting the foot and ankle
- Acquired deformities or dysfunction resulting from trauma or neurological conditions
Patients suitable for this procedure typically present with significant functional impairment affecting their gait and balance.
Preparation
- Fasting as directed by the healthcare provider
- Adjustments or discontinuation of certain medications as recommended (e.g., blood thinners)
- Pre-operative assessment including physical examination, imaging studies (e.g., X-rays, MRI), and possibly nerve conduction studies
Procedure Description
- Administer appropriate anesthesia (most often general or regional anesthesia).
- Make an incision over the site of the tendon to be transferred.
- Carefully release the tendon from its original attachment.
- Reroute the tendon through a new path to its intended destination in the midfoot.
- Securely attach the tendon to a new bone or tendon attachment point.
- Close the incision with sutures and cover with sterile dressing.
Tools may include scalpels, retractors, sutures, and various orthopedic instruments.
Duration
The procedure typically takes about 1-2 hours, although this can vary depending on the complexity of the case.
Setting
This surgery is performed in a hospital or surgical center equipped with an operating room.
Personnel
- Orthopedic surgeon or podiatric surgeon
- Anesthesiologist or nurse anesthetist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Tendon re-rupture or failure
- Prolonged pain or swelling
- Adverse reaction to anesthesia
Benefits
- Improved foot function
- Enhanced mobility and gait
- Reduction in pain or discomfort
- Potential for long-term correction of deformity
These benefits may be realized within several weeks to a few months post-surgery.
Recovery
- Initial immobilization of the foot using a cast or brace
- Gradual introduction to physical therapy to build strength and motion
- Restrictions on weight-bearing activities as recommended by the surgeon
- Follow-up appointments to monitor healing and progress
Full recovery typically spans several months, with gradual reintroduction to normal activities.
Alternatives
- Physical therapy only (non-surgical)
- Orthotic devices to support and stabilize the foot
- Other surgical options such as different types of tendon transfers or foot reconstruction
Each alternative has its own set of pros and cons which should be discussed with the healthcare provider to determine the best individual approach.
Patient Experience
During the procedure, the patient will be under anesthesia and should not feel pain. Post-operative discomfort is managed with pain medications, and patients can expect some swelling and limited mobility initially. Comfort measures such as elevation and ice packs may be recommended to reduce swelling and promote healing.