CPT® Code 64891

1. Indications

The nerve graft procedure is indicated for patients who have sustained nerve injuries in the hand or foot that require surgical intervention to restore function. The following conditions may warrant the use of this procedure:

• Severe Nerve Injury: When a nerve has been significantly damaged due to trauma, laceration, or other injuries, necessitating repair to restore sensation and motor function.
• Neuroma: The presence of a neuroma, which is a growth or tumor of nerve tissue, may require grafting to alleviate pain and restore nerve continuity.
• Congenital Defects: In cases where individuals are born with nerve abnormalities that affect function, a nerve graft may be indicated to correct these issues.
• Post-Surgical Complications: Nerve damage resulting from previous surgical procedures may also necessitate a nerve graft to repair the affected area.

2. Procedure

The nerve graft procedure consists of several critical steps to ensure successful repair of the injured nerve. Each step is essential for achieving optimal outcomes.

• Step 1: Exposure of the Injured Nerve - The surgeon begins by making an incision to expose the injured nerve. This allows for a thorough evaluation of the extent of the nerve damage, which is crucial for determining the appropriate course of action.
• Step 2: Debridement of Damaged Tissue - If there is any necrotic or damaged tissue surrounding the nerve, it is carefully debrided to prepare the site for grafting. This step is vital to ensure that only healthy tissue is involved in the repair process.
• Step 3: Nerve Testing and Monitoring - To assess the function of the nerve, the surgeon may perform nerve testing and monitoring. These evaluations help in understanding the degree of nerve injury and guide the surgical approach.
• Step 4: Microscopic Visualization - Utilizing microscopic techniques, the surgeon dissects the healthy proximal and distal segments of the nerve free from surrounding tissue. This precision is necessary to ensure that the graft can be properly aligned with the nerve ends.
• Step 5: Harvesting the Nerve Graft - A single strand nerve graft is harvested from a donor site. The donor nerve is exposed, and the desired length is carefully dissected free from surrounding tissue. The graft is then divided proximally and distally for implantation.
• Step 6: Suturing the Graft - The harvested nerve graft is sutured end-to-end to the severed ends of the injured nerve. This connection is critical for re-establishing nerve continuity and function.
• Step 7: Repair of Overlying Tissues - Finally, the surgeon repairs the overlying soft tissues and skin in layers to ensure proper healing and minimize scarring.

3. Post-Procedure

After the nerve graft procedure, patients can expect a recovery period that may vary depending on the extent of the injury and the surgical intervention. Post-operative care typically includes monitoring for signs of infection, managing pain, and ensuring proper wound healing. Patients may also undergo physical therapy to regain strength and function in the affected area. Follow-up appointments are essential to assess the success of the graft and the recovery of nerve function. It is important for patients to adhere to their surgeon's post-operative instructions to optimize healing and functional recovery.