CPT® Code 26356

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); primary, without free graft, each tendon

The CPT® Code 26356 refers to the surgical procedure for the repair or advancement of a flexor tendon located in zone 2 of the digital flexor tendon sheath, commonly known as "no man's land." This area is critical for hand function and is defined anatomically as the region between the insertion of the flexor digitorum superficialis tendon and the proximal A1 pulley, extending from the proximal end of the proximal phalanx to the distal end of the middle phalanx. Injuries to the flexor tendons can manifest as partial or complete lacerations, tears, or ruptures, necessitating surgical intervention to restore function. The procedure described by this code is a primary repair, which is typically performed within 24 hours of the injury to optimize healing outcomes. However, in cases where the wound is grossly contaminated, the primary repair may be delayed for up to two weeks. If the repair is conducted after this period, it is classified as a secondary repair. The surgical approach involves exposing the tendon through a volar zigzag or lateral incision, with careful dissection of soft tissues to protect surrounding neurovascular structures. The surgeon locates the distal and proximal ends of the severed tendon, which may require additional incisions if the proximal end has retracted. The primary suture repair involves approximating and suturing the tendon ends together to restore continuity and function.