CPT® Code 64861

1. Indications

The suture of the brachial plexus is indicated for specific types of nerve injuries that may result from various traumatic events. The following conditions warrant this surgical intervention:

• Traumatic Nerve Injury - Injuries caused by sharp objects that penetrate the nerve tissue, leading to disruption of nerve function.
• Severed Nerves - Complete transection of the brachial plexus nerves that necessitates surgical repair to restore function.
• Compression Injuries - Situations where the nerve is compressed or damaged due to external forces, requiring surgical intervention to relieve pressure and repair the nerve.

2. Procedure

The procedure for suturing the brachial plexus involves several critical steps to ensure effective repair of the damaged nerves. Each step is designed to facilitate optimal healing and restore nerve function:

• Step 1: Exposure of the Injury Site - The surgical team begins by making an incision to expose the site of the brachial plexus injury. This allows for direct visualization and assessment of the extent of the damage to the nerve.
• Step 2: Exploration and Debridement - Once the injury site is exposed, the surgeon explores the area to determine the severity of the nerve damage. Any necrotic or damaged tissue is carefully debrided to prepare the nerve ends for repair.
• Step 3: Nerve Function Testing - Intraoperative nerve function testing may be performed to assess the viability of the nerve and to guide the repair process. This step is crucial for determining the appropriate surgical approach.
• Step 4: Dissection of Nerves - The injured nerves are meticulously dissected from the surrounding tissues both proximal and distal to the injury site. This dissection is essential for achieving proper alignment of the nerve ends during suturing.
• Step 5: Suture Repair Techniques - The surgeon may choose between different suture techniques, such as epineural repair, where sutures are placed in the epineurium of the nerve ends, or perineural closure, which involves suturing individual fascicles of axons together. The choice of technique depends on the specific nature of the injury.
• Step 6: Closure of the Nerve - The closure process involves suturing the deeper fascicles first and then moving toward the nerve surface, ensuring that all structures are repaired. If necessary, additional sutures may be placed to maintain alignment of the fascicles.
• Step 7: Individual Nerve Repair - Each severed nerve in the brachial plexus is repaired separately, ensuring that the repair is tailored to the specific injury and that the functional integrity of the nerve is restored as much as possible.

3. Post-Procedure

After the suture repair of the brachial plexus, patients typically require careful monitoring and follow-up care to ensure proper healing and recovery. Post-procedure care may include pain management, physical therapy, and rehabilitation to restore function and strength in the affected upper extremity. Patients are advised to follow their surgeon's instructions regarding activity restrictions and any signs of complications that should be reported. The expected recovery time can vary based on the severity of the injury and the success of the repair, with ongoing assessments to evaluate nerve function and overall progress.