64778 Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary procedure)

Name of the Procedure:

Excision of Neuroma; Digital Nerve, Each Additional Digit (List separately in addition to code for primary procedure)

Summary

In simpler terms, this procedure involves surgically removing a neuroma, which is a painful growth of nerve tissue, from additional finger or toe nerves beyond the first one treated. This is done as an additional step to a primary surgery where the initial nerve excision took place.

Purpose

This procedure aims to relieve pain and discomfort caused by neuromas, which are often the result of nerve damage or irritation. The primary goal is to remove the source of pain and prevent further symptoms such as tingling, numbness, or limited mobility.

Indications

• Symptoms like persistent pain, burning, or tingling in the fingers or toes.
• Diagnosis of a neuroma causing considerable distress and impacting daily activities.
• Failure of non-surgical treatments such as medication or physical therapy.

Preparation

• Patients may need to fast for a certain period before surgery.
• Adjustments in current medications may be required.
• Pre-operative imaging studies or nerve conduction tests may be performed to locate the neuroma accurately.

Procedure Description

1. The patient will be given regional or general anesthesia.
2. The surgeon makes an incision near the affected area.
3. The neuroma is carefully identified and excised.
4. The incision is then closed with sutures.
5. This process is repeated for each additional digit requiring neuroma excision.
   • Specialized surgical tools and imaging technology may be used to aid precision.

Duration

Typically, the excision of neuromas for additional digits takes about 30 minutes per digit, but this varies based on the complexity of the case.

Setting

This procedure can be performed in a hospital, outpatient clinic, or surgical center, often depending on the extent of the surgery and the patient's overall health.

Personnel

• Surgeon specializing in nerve surgery.
• Nursing staff.
• Anesthesiologist or nurse anesthetist.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Nerve damage leading to numbness or altered sensation.
• Recurrence of symptoms.
• Scarring at the incision site.

Benefits

• Reduction or elimination of pain associated with neuroma.
• Restoration of normal sensation and function in the affected digits.
• Improved quality of life and ability to perform daily activities.

Recovery

• Patients will receive post-operative instructions including wound care and activity restrictions.
• Pain management might include prescribed medications.
• Recovery time varies but generally includes a few weeks of reduced activity.
• Follow-up appointments will be scheduled to monitor healing and address any concerns.

Alternatives

• Non-surgical treatments such as physical therapy, orthotic devices, or corticosteroid injections.
• Radiofrequency ablation or alcohol sclerosing injections.
• Each alternative comes with its benefits and limitations, often depending on the severity and persistence of symptoms.

Patient Experience

During the procedure, the patient will not feel pain due to anesthesia but may feel some pressure or movement. Post-operatively, there may be pain and swelling managed with medications and ice. Comfort measures and detailed instructions will be provided to ensure a smooth recovery process.