CPT® Code 26352

Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); secondary with free graft (includes obtaining graft), each tendon

Repair or advancement of the flexor tendon, specifically coded as CPT® Code 26352, refers to a surgical procedure aimed at addressing injuries to the flexor tendons in the hand that are not located within zone 2 of the digital flexor tendon sheath, commonly referred to as "no man's land." This procedure is particularly relevant for cases involving partial or complete lacerations, tears, or ruptures of the flexor tendons. The flexor tendons are categorized into zones based on their anatomical location, with zone 1 encompassing injuries distal to the insertion of the flexor digitorum superficialis (FDS) tendon, which primarily involves the profundus tendon. Zone 3 pertains to injuries occurring in the palm, extending from the distal carpal ligament to the distal palmar crease. The timing of the repair is crucial; primary repairs are ideally conducted within 24 hours of the injury, although in cases of significant wound contamination, this may be postponed for up to two weeks. Secondary repairs, as indicated by this code, are performed more than two weeks post-injury. The surgical approach typically involves exposing the tendon through a volar zigzag or lateral incision, with careful dissection of the surrounding soft tissues to protect vital neurovascular structures. The surgeon locates the distal and proximal ends of the severed tendon, which may necessitate an additional incision if the proximal end has retracted. In the context of CPT® Code 26352, the procedure involves a secondary repair utilizing a free graft, which includes the harvesting of a tendon graft—often the palmaris longus from the distal forearm. This graft is then meticulously attached to the affected flexor muscle, usually at the wrist, and tunneled to the appropriate site for secure attachment, ensuring proper healing and function of the tendon.