CPT® Code 25316

1. Indications

The flexor origin slide with tendon transfer procedure is indicated for patients experiencing significant functional limitations due to flexion contractures of the wrist and hand. The specific conditions that may warrant this surgical intervention include:

• Cerebral Palsy - A neurological condition that affects movement and muscle coordination, often leading to contractures.
• Volkmann Contracture - A condition resulting from ischemic injury to the muscles and soft tissues of the forearm, leading to muscle shortening and contractures.

2. Procedure

The procedure for CPT® Code 25316 involves several detailed steps to ensure effective release of contractures and successful tendon transfer. The following outlines the procedural steps:

• Step 1: Incision and Exposure - A longitudinal incision is made over the donor tendon, which is the tendon that will be transferred. This incision allows for direct access to the tendon, facilitating its exposure and preparation for transfer.
• Step 2: Donor Tendon Preparation - The donor tendon is carefully freed from its attachments to ensure it can be mobilized effectively. This may involve detaching the tendon along with a strip of periosteum to maintain its blood supply and structural integrity. Additionally, the muscle associated with the tendon is released from fascial attachments to maximize its length and mobility.
• Step 3: Recipient Site Preparation - A second incision is made over the recipient site, which is the area where the donor tendon will be attached. This site is prepared to receive the tendon, ensuring that it can be secured properly.
• Step 4: Routing and Securing the Donor Tendon - The donor tendon is routed to the recipient site and temporarily secured with sutures. This step is crucial for ensuring proper alignment and function of the tendon once it is permanently attached.
• Step 5: Function Testing - A neuromuscular stimulator is utilized to test the function of the donor tendon. This allows the surgeon to assess the tendon’s responsiveness and make any necessary adjustments to its tension to optimize function.
• Step 6: Permanent Securing - Once the tension is adjusted to ensure maximum function, the donor tendon is permanently secured at the recipient site, completing the transfer process.
• Step 7: Closure and Immobilization - After all surgical steps are completed, the surgical wounds are closed, and the wrist and/or hand is immobilized in an extended position to promote healing and prevent complications.

3. Post-Procedure

Following the flexor origin slide with tendon transfer procedure, patients are typically required to undergo a period of immobilization of the wrist and hand in an extended position. This is essential to allow for proper healing of the surgical sites and to maintain the new positioning of the tendons. Patients may also need to participate in a rehabilitation program that includes physical therapy to regain strength and function in the wrist and hand. The recovery process may vary depending on individual circumstances, but close monitoring for any complications and adherence to post-operative care instructions are critical for optimal outcomes.