64910 Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve

Name of the Procedure:

Nerve Repair with Synthetic Conduit or Vein Allograft (e.g., nerve tube)

Summary

Nerve repair using a synthetic conduit or vein allograft is a surgical technique where damaged nerves are repaired by using synthetic tubes or donor veins. These conduits guide nerve regeneration by providing a scaffold for the regrowth of nerve fibers.

Purpose

The primary purpose of this procedure is to restore function and sensation in areas affected by nerve damage. It aims to bridge gaps in the nerve that cannot heal on their own, allowing the nerve fibers to regenerate correctly and enabling the patient to regain motor and sensory functions.

Indications

• Severe nerve damage or injury resulting in loss of function or sensation
• Nerve gaps that are too large for spontaneous healing
• Neuropathies that have not responded to other treatments
• Deficits due to trauma, surgical injuries, or chronic conditions

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications, especially blood thinners, might be necessary.
• Preoperative imaging studies, like MRI or nerve conduction studies, may be conducted.
• Detailed medical history and physical examination.

Procedure Description

1. The patient is brought to the surgical facility and prepared for surgery.
2. General or regional anesthesia is administered.
3. The surgeon makes an incision near the site of nerve damage.
4. The damaged nerve ends are identified, and the gap between them is measured.
5. A synthetic conduit or vein allograft is selected based on the gap size.
6. The conduit or allograft is placed to bridge the nerve ends, securing it with micro-sutures.
7. The incision site is closed with sutures, and the area is bandaged.

Duration

The procedure typically takes 1-3 hours, depending on the complexity of the nerve repair and the size of the nerve gap.

Setting

This procedure is generally performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically a neurosurgeon or orthopedic surgeon)
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Adverse reactions to anesthesia
• Failure of the nerve to regenerate properly
• Scar tissue formation
• Chronic pain or hypersensitivity at the repair site
• Bleeding or hematoma

Benefits

• Restoration of motor and sensory functions
• Improved quality of life and daily functioning
• Pain relief if nerve damage was causing chronic pain
• Earlier recovery and return of function compared to natural healing

Recovery

• Post-operative care includes wound care and possibly wearing a splint.
• Patients may need physical therapy to regain strength and function.
• Pain management with prescribed medications.
• Follow-up appointments to monitor nerve healing and recovery.
• Recovery time varies but can range from several weeks to months depending on the extent of nerve damage and patient’s healing response.

Alternatives

• Autologous nerve graft (using the patient's own nerve tissue)
• Conservative management with medication and physical therapy
• Electrical stimulation therapies
• Benefits of nerve repair with conduit/allograft include reduced donor site morbidity and potentially quicker recovery.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel any discomfort.
• Post-operative pain is managed with medications.
• Patients may experience tingling, numbness, or discomfort at the repair site during healing.
• Gradual improvement in motor and sensory functions is expected over time, determined by the extent of injury and individual healing processes.