Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision)
CPT4 code
Name of the Procedure:
Implantation of nerve end into bone or muscle
Common name(s): Nerve implantation, Targeted muscle reinnervation, Neuroma management
Technical term: Implantation of nerve end into bone or muscle
Summary
This procedure involves placing the end of a severed or damaged nerve into either bone or muscle tissue. It is often done in addition to the removal of a neuroma, which is a painful nerve growth. The implantation helps to reduce pain and prevent the formation of another neuroma.
Purpose
Medical Condition: This procedure addresses pain and discomfort caused by neuromas or nerve damage.
Goals: The main objectives are to reduce pain, prevent the recurrence of neuromas, and improve overall nerve function.
Indications
Symptoms/Conditions:
- Chronic pain at the site of a neuroma
- Repeated formation of neuromas
- Pain following amputation (phantom limb pain)
- Nerve injury pain that hasn’t responded to other treatments
Patient Criteria:
- Persistent pain despite conservative treatments
- Confirmed diagnosis of a neuroma or nerve damage
Preparation
Pre-procedure Instructions:
- Fasting may be required for a certain period before surgery.
- Adjustments to medications, especially blood thinners, as directed by your doctor.
- Pre-operative blood tests and imaging studies like MRI or ultrasound to locate the exact position of the nerve and neuroma.
Procedure Description
- Anesthesia: The procedure is typically performed under general anesthesia.
- Incision: A careful incision is made to expose the nerve and associated neuroma.
- Neuroma Excision: The neuroma is surgically removed.
- Nerve Redirection: The severed end of the nerve is directed and implanted into nearby bone or muscle tissue.
- Closure: The incision is closed with sutures or staples and dressed to minimize infection risk.
Tools/Equipment: Surgical instruments, sutures, sterilized dressings
Duration
The procedure generally takes about 1 to 2 hours, depending on the complexity and extent of the neuroma and nerve damage.
Setting
The procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeons: Usually a specialized hand or peripheral nerve surgeon
- Nurses: Perioperative and surgical nurses
- Anesthesiologists: To administer and monitor anesthesia
- Surgical Technicians
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Scar tissue formation at the incision site
Rare Risks:
- Nerve damage
- Chronic pain or discomfort
- Incomplete pain relief
Complications Management: Antibiotics for infections, pain management strategies for chronic pain, follow-up surgeries if necessary.
Benefits
Expected Benefits:
- Significant reduction in pain
- Lower risk of neuroma recurrence
- Improved nerve function
- Benefits might be realized within a few weeks to months post-surgery.
Recovery
Post-procedure Care:
- Wound care and keeping the incision area clean
- Pain management with prescribed medications
- Physical therapy may be recommended to aid recovery
Expected Recovery Time:
- Initial healing within 2-3 weeks
- Full recovery might take several months
Restrictions/Follow-up:
- Limited physical activity for initial weeks
- Follow-up appointments to monitor healing and nerve function
Alternatives
Other Treatment Options:
- Conservative treatments (physical therapy, medications)
- Radiofrequency ablation
- Non-surgical nerve blocks
Pros and Cons of Alternatives:
- Less invasive options may be preferable for some but may not provide permanent relief.
- Surgical options can provide long-term relief but come with higher risks.
Patient Experience
During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, discomfort or moderate pain around the surgery site is common and can be managed with medications. Recovery may involve some temporary restrictions on movement and physical therapy sessions to regain strength and function.
Pain management and comfort measures are prioritized to ensure a smooth recovery process.