Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary neurorrhaphy)
CPT4 code
Name of the Procedure:
Suture of Nerve; Requiring Secondary or Delayed Suture (Secondary Neurorrhaphy)
Summary
This procedure involves the delayed or secondary suturing of a nerve that has been damaged or severed. It is typically performed after the initial injury has been stabilized and initial treatment has been completed.
Purpose
The procedure addresses nerve damage that has not healed on its own or where primary nerve repair was not initially performed. The goal is to restore nerve function, improve sensation, and reduce pain or dysfunction caused by the nerve injury.
Indications
- Severe nerve injury or severance
- Delayed healing or failure of initial nerve healing
- Persistent loss of sensation or motor function
- Chronic pain or disability linked to nerve damage
- Suitable for patients who did not receive primary neurorrhaphy or whose previous repair has failed.
Preparation
- Fasting for at least 6-8 hours if general anesthesia will be used
- Medication adjustments based on the patient's current medications (e.g., blood thinners)
- Preoperative imaging or nerve conduction studies to assess the extent of nerve damage
Procedure Description
- An incision is made over the damaged nerve area.
- The nerve ends are located and examined.
- The surgeon prepares the nerve ends by trimming any scar tissue.
- Using microsurgical techniques, the nerve ends are carefully aligned.
- The nerve is sutured using fine sutures under a microscope or magnification.
- The incision is closed, and a sterile dressing is applied.
Tools and equipment include microsurgical instruments, fine sutures, a microscope or surgical magnification tools. General or regional anesthesia is typically used.
Duration
The procedure can take between 1 to 3 hours, depending on the complexity and extent of the nerve damage.
Setting
The procedure is performed in a hospital or surgical center that is equipped for microsurgery.
Personnel
- Surgeon with expertise in nerve repair
- Anesthesiologist
- Surgical nurses and assistants
- Possibly a microsurgical specialist
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Failure of the nerve to heal properly
- Allergic reactions to anesthesia
- Scarring or excessive scar tissue formation
- Nerve pain or neuroma development
Benefits
- Improved nerve function and sensation
- Reduction in pain or discomfort associated with nerve damage
- Enhanced ability to perform daily activities
Recovery
- Post-procedure monitoring for a few hours if under general anesthesia
- Pain management with prescribed medications
- Instructions to keep the surgical site clean and dry
- Follow-up appointments for wound inspection and removal of stitches
- Physical therapy may be recommended to restore function
- Full recovery may take several weeks to months depending on the individual case
Alternatives
- Conservative management with physical therapy and medications
- Primary neurorrhaphy if early intervention is possible
- Nerve grafting or other nerve repair techniques
- Use of orthotic devices to manage symptoms
Patient Experience
Patients may experience mild to moderate pain during recovery, which is managed with pain medications. Numbness or tingling in the affected area is common initially. Most patients will gradually regain sensation and function over time, with significant improvement noted by follow-up evaluations.