CPT® Code 26350

Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon

The CPT® Code 26350 refers to the surgical procedure for the repair or advancement of a flexor tendon that is not located in zone 2 of the digital flexor tendon sheath, commonly referred to as "no man's land." This procedure can be performed as either a primary or secondary repair and does not involve the use of a free graft. Flexor tendons are critical structures in the hand that allow for the bending of fingers, and injuries to these tendons can result in significant functional impairment. The common types of injuries include partial or complete lacerations, tears, or ruptures. The flexor tendons are categorized into zones, with zone 1 encompassing injuries distal to the insertion of the flexor digitorum superficialis (FDS) tendon, primarily affecting the profundus tendon. Zone 3 injuries occur in the palm, extending from the distal carpal ligament to the distal palmar crease. Primary repairs are ideally conducted within 24 hours following the injury to optimize healing outcomes; however, in cases where the wound is grossly contaminated, this repair may be postponed for up to two weeks. Secondary repairs are defined as those performed more than two weeks after the initial injury. The surgical approach typically involves a volar zigzag or lateral incision to expose the tendon, with careful dissection of soft tissues to protect surrounding neurovascular structures. Once the severed tendon ends are located, they are approximated and sutured together. Each tendon repaired is reported separately under this code, emphasizing the importance of accurate coding for each tendon involved in the procedure.