CPT® Code 64862

1. Indications

Indications for the suture of the lumbar plexus include the following:

• Traumatic Nerve Injury - This procedure is performed in cases of nerve damage resulting from penetrating injuries caused by sharp objects.
• Loss of Sensation - Patients may present with sensory deficits in the lower extremities due to nerve injury.
• Motor Dysfunction - The procedure is indicated when there is a loss of motor function in the lower limbs as a result of lumbar plexus injury.

2. Procedure

The procedure for suturing the lumbar plexus involves several critical steps to ensure effective repair of the damaged nerves.

• Step 1: Exposure and Exploration - The site of the lumbar plexus injury is surgically exposed, allowing the surgeon to explore the area and assess the extent of the nerve damage. This step is crucial for determining the appropriate course of action for repair.
• Step 2: Debridement - Any damaged or necrotic tissue surrounding the injured nerves is carefully debrided. This process helps to clear the area of any debris that could impede healing and ensures that only healthy tissue is present for the repair.
• Step 3: Nerve Dissection - The injured nerves are meticulously dissected from the surrounding tissues both proximal and distal to the injury site. This dissection is essential for accessing the nerve ends that need to be repaired.
• Step 4: Suture Repair Techniques - The surgeon may choose between different suture repair techniques. An epineural repair involves placing several sutures in the epineurium of each nerve end to approximate them without tension. Alternatively, a perineural closure may be performed, where the epineurium is pulled back to expose individual fascicles of axons, which are then sutured together. This may require multiple sutures to ensure proper alignment and closure of the fascicles.
• Step 5: Closure of Nerve Structures - The closure is performed by suturing the deeper fascicles first, gradually moving toward the nerve surface until all structures are securely repaired. This layered approach helps to restore the integrity of the nerve.
• Step 6: Separate Repairs - Each severed nerve within the lumbar plexus is repaired separately to ensure precise restoration of function and sensation.

3. Post-Procedure

Post-procedure care following the suture of the lumbar plexus involves monitoring the patient for signs of recovery and potential complications. Patients may require pain management and physical therapy to aid in rehabilitation. The expected recovery period can vary based on the extent of the injury and the success of the repair. Regular follow-up appointments are essential to assess nerve function and ensure that the patient is regaining sensation and motor control in the lower extremities. Any signs of infection or complications should be addressed promptly to facilitate optimal healing.